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1. Arterial hypertension diagnosis: A problem?

Author

M. Serrat-Costa, G. Coll de Tuero, C. Bertran Noguer, R. Martí Lluch, R. Ramos Blanes, A. Baltasar Bagué, and W. Ricart

Subjects
Internal Medicine, Cardiology and Cardiovascular Medicine
Abstract

Arterial hypertension (AHT), a leading risk factor in terms of attributable mortality, is a major public health problem, especially for primary care where most patients are diagnosed and followed up. Correct AHT diagnosis requires adequate theoretical knowledge and technical skills in physicians and nurses. The aim of this study was to evaluate the knowledge and skills used in initial AHT diagnosis by health professionals and to describe the factors that contribute to variability.Cross-sectional observational study in a sample of 385 primary care physicians and nurses recruited in a Catalan health region. Using a validated questionnaire called ARC, we evaluated theoretical knowledge and analysed factors that may contribute to response variability. We also evaluated practical measurement skills using objective structured clinical examination tests.Medical and nursing primary care professionals had deficient knowledge and skills for initial AHT diagnosis and measurement, despite self-perceiving their knowledge to be sufficient. However, professionals who had received postgraduate or other AHT training in the previous year scored better in the ARC questionnaire.The results of this study point to insufficient AHT expertise to ensure quality clinical practice, suggesting that ongoing theoretical and practical training needs to be improved.

Published
2022

3. Primer cuestionario internacional validado sobre los conocimientos de los profesionales de la salud en el diagnóstico de la hipertensión arterial

Author

M. Serrat-Costa, Y. Serra-Martínez, J. Cabrero-García, C. Bertrán-Noguer, G.L. Delclos, G. Coll-de-Tuero, R. Ramos-Blanes, W. Ricart, Universidad de Alicante. Departamento de Enfermería, and Calidad de Vida, Bienestar Psicológico y Salud

Subjects
Health Knowledge, Attitudes, Practice, Questionnaire, Reproducibility of Results, Primary care, Atención primaria, Profesionales de la salud, Knowledge, Conocimiento, Surveys and Questionnaires, Hipertensión, Hypertension, Internal Medicine, Health professionals, Humans, Enfermería, Cardiology and Cardiovascular Medicine, Cuestionario, Language
Abstract

Introduction: Arterial hypertension is the main factor in attributable mortality. It is therefore considered one of the most important public health problems. Health professionals require special training and skills to make a diagnosis. No studies have been found in the literature search that use a validated instrument (questionnaire) to assess health professionals’ theoretical and practical knowledge in diagnosing hypertension or measuring blood pressure. Aim: To design and validate an instrument for gauging health professionals’ theoretical knowledge in measuring blood pressure for the initial diagnosis of hypertension. Methodology: Design, development, and validation of a questionnaire in three languages (English, Spanish, and Catalan) to assess knowledge based on the Rasch-item response theory model. Results: A questionnaire in three languages was constructed and validated. It consisted of 23 questions on the theoretical knowledge of the initial diagnosis of hypertension and was called the ARC questionnaire. It met all the Rasch-IRT model criteria: item- and person-fit measurement, unidimensionality, local independence, invariance, targeting, and reliability. Conclusions: The ARC questionnaire is a validated tool that enables objective and uniform analyses of knowledge in the initial diagnosis of hypertension among medical and nursing professionals, comparing them over time. It allows for established strategies to be developed to enhance this knowledge. Introducción: La hipertensión arterial es el principal factor de mortalidad atribuible. Es por eso que se considera uno de los problemas de salud pública más importantes. Los profesionales de la salud necesitan una formación y unas habilidades especiales para realizar un diagnóstico. En la literatura actual no se han encontrado estudios que utilicen un instrumento validado (cuestionario) para evaluar los conocimientos teóricos y prácticos de los profesionales de la salud en el diagnóstico de la hipertensión o medición de la tensión arterial. Objetivo: Diseñar y validar un instrumento para medir los conocimientos teóricos de los profesionales de la salud en la medida de la tensión arterial para el diagnóstico inicial de la hipertensión. Metodología: Diseño, desarrollo y validación de un cuestionario en tres idiomas (inglés, español y catalán) para evaluar los conocimientos basados en el modelo de Rasch (teoría de la respuesta al ítem). Resultados: Se construyó y validó un cuestionario en tres idiomas. Constaba de 23 preguntas sobre los conocimientos teóricos en el diagnóstico inicial de hipertensión que se denominó cuestionario ARC. Cumplió con todos los criterios del modelo Rasch-IRT: medición de ajuste (fit) al ítem y a la persona, unidimensionalidad, independencia local, invarianza, targeting y fiabilidad. Conclusiones: El cuestionario ARC es una herramienta validada que permite realizar análisis objetivos y uniformes de los conocimientos en el diagnóstico inicial de la hipertensión entre profesionales de medicina y de enfermería, comparándolos en el tiempo. Permite desarrollar estrategias establecidas para potenciar este conocimiento.

Published
2021

4. Obesidad e inflamación

Author

José Manuel Fernández-Real, W. Ricart, and M. Recasens

Abstract

El tejido adiposo lejos de ser un conjunto de células inertes, es capaz de producir un número elevado de moléculas, llamadas adipocitoquinas entre las que se encuentran la leptina, factor de necrosis tumoral (TNF), interleuquinas y adiponectina. Las alteraciones metabólicas que tienen lugar en la obesidad y en el síndrome metabólico pueden verse influenciadas por el grado de producción de las adipocitoquinas. El tejido adiposo contribuye a la activación del sistema TNF merced a su contribución a incrementar las fracciones solubles de su receptor, que se relaciona con el índice de masa corporal. La activación del sistema TNF se ha relacionado con la resistencia insulínica a través de generar defectos en la fosforilación del receptor y de disminuir la expresión de los transportadores de glucosa sensibles a la insulina. Adicionalmente, el TNF parece jugar un papel en la fisiopatología de la hipertensión arterial asociada a la obesidad y en la dislipemia que acompaña a la resistencia insulínica. La tercera parte de la concentración de Interleuquina-6 (IL-6) proviene del tejido adiposo. IL-6 parece relacionada con la dislipemia, alteraciones en la tolerancia hidrocarbonada e hipertensión arterial. En contraste con TNF e IL-6, la adiponectina, producida también por el tejido adiposo, posee un papel favorecedor de la sensibilidad insulínica y protector de la arteriosclerosis además de tener propiedades antiinflamatorias. Al contrario que el resto de adipocitoquinas conocidas, la adiponectina está disminuida en la obesidad, diabetes y en la enfermedad cardiovascular, circunstancias todas ellas asociadas a resistencia insulínica. Su administración a animales de experimentación reduce la resistencia insulínica y los niveles de triglicéridos en músculo e hígado. También se ha demostrado que inhibe la adhesión celular al endotelio, exhibiendo un efecto antiarteriosclerótico. En conjunto, las citoquinas segregadas por el tejido adiposo tienen un papel muy importante en la fisiopatología del síndrome metabólico actuando sobre la señalización de insulina, fibrinolisis y adhesión celular al endotelio.

Published
2017
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8. Are nurses sufficiently well prepared to take on the detection of hypertension?

Author

D. Juvinyà Canal, A. Baltasar Bagué, W. Ricart, M. Serrat-Costa, C. Bertran Noguer, and R. Machado Velasco

Subjects
Adult, Percentile, Health Knowledge, Attitudes, Practice, Lower score, Nurses, Primary care, 030204 cardiovascular system & hematology, Multiple linear regression model, 03 medical and health sciences, Nursing care, 0302 clinical medicine, Nursing, Internal Medicine, Medicine, Humans, 030212 general & internal medicine, Aged, Adult patients, business.industry, Middle Aged, Test (assessment), Cross-Sectional Studies, Health Care Surveys, Hypertension, Observational study, Clinical Competence, Cardiology and Cardiovascular Medicine, business
Abstract

Background The detection of arterial hypertension requires training and knowledge by the responsible health professional. The current guidelines recommend doctors and nurses to work together for the screening of hypertension. Objectives To assess the level of knowledge among primary healthcare nurses’ in the screening of arterial hypertension. Methods Descriptive, observational and transversal study. A random representative sample of 165 nurses working with adult patients in community-based primary healthcare centres were asked to complete an evaluation test of theoretical knowledge about hypertension. Higher scores indicated a greater knowledge about the detection of hypertension. Results 32.1% of the participants obtained a score equal to or more than 72.7 which corresponded to the 75th percentile of correct answers. Nurses with lower scores were older, permanent employees with technical training studies. A higher age and technical training studies contributed independently to a lower score. In the multiple linear regression model, age and type of studies contributed independently to questionnaire's score variance. Conclusion Currently, primary care nurses in the studied region do not have sufficient theoretical knowledge to detect hypertension. The results show the need to establish strategies to achieve the necessary knowledge for the implementation of a correct hypertension screening. For professional nurses, continuing education is essential to safe and effective nursing care.

Published
2016

9. La resistencia a la insulina como mecanismo de adaptación durante la evolución humana

Author

J.M. Fernández-Real and W. Ricart

Subjects
Endocrinology, Diabetes and Metabolism, Type 2 Diabetes Mellitus, Biology, medicine.disease, Obesity, Endocrinology, Immune system, Insulin resistance, Diabetes mellitus, medicine, Metabolic syndrome, Adaptation, Neuroscience, Coevolution
Abstract

The recent application of concepts of evolution to human disease is proving useful to understand certain pathophysiological mechanisms of different entities that span genomic alterations of immunity, respiratory and hormone function, and the circulatory and neural systems. However, effort has concentrated on explaining the keys to adaptation that define human metabolism and, since the early 1960s, several theories have been developed. This article reviews some of the hypotheses postulated in recent years on the potential benefit of insulin resistance and discusses the most recent knowledge. The concept of the thrifty gene seems to have been definitively refuted by current knowledge. The current paradigm describes an interaction between the metabolic and the immune systems resulting from their coevolution, promoted by evolutionary pressures triggered by fasting, infection and intake of different foods. The activation and regulation of these ancient mechanisms in integrated and interdependent areas defines insulin resistance as a survival strategy that is critical during fasting and in the fight against infection. The relationship with some components of the diet and, particularly, with the symbiotic intestinal microflora points to new paradigms in understanding the pathophysiology of obesity, metabolic syndrome and type 2 diabetes mellitus.

Published
2010
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10. Glitazonas

Author

E. Juncà and W. Ricart

Subjects
Endocrinology, Endocrinology, Diabetes and Metabolism
Published
2008
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11. Hierro, resistencia a la insulina y riesgo cardiovascular

Author

W. Ricart, José Manuel Fernández-Real, and E. Esteve

Subjects
Pharmacology (medical), Cardiology and Cardiovascular Medicine
Abstract

En los ultimos anos el metabolismo del hierro se ha relacionado con la resistencia a la insulina, con la diabetes mellitus tipo 2 y con los procesos de inflamacion y estres oxidativo que contribuyen al desarrollo de arteriosclerosis. Hasta hace bien poco, la sobrecarga ferrica se circunscribia a la hemocromatosis y a los trastornos relacionados. El descubrimiento de las mutaciones HFE y un nuevo sindrome denominado sobrecarga ferrica asociada a insulinorresistencia han contribuido a ampliar el conocimiento de las repercusiones que este metal posee sobre nuestra fisiologia. En este articulo se revisa la influencia del metabolismo del hierro en la etiopatogenia y la expresion de diferentes procesos relacionados con la aterosclerosis y la inflamacion. Tambien se aborda el posible papel de las medidas terapeuticas que disminuyen la toxicidad del hierro en la prevencion y el tratamiento de la disfuncion endotelial, la diabetes mellitus y la aterosclerosis.

Published
2004
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12. Evolución ponderal en la población de Girona, 1989-1999

Author

J.M. Fernández-Real, M.A. Barceló, P. Badosa, R. Girona, D. Faixedas, J.M. Garrido, Carme Saurina, M. Sáez, A. Marqués, M. Gómez-Mata, W. Ricart, J.M. García-Rafanell, C. Viñets, D. Serrà, M. Faixedas, M. Andreu, and M. Torra

Subjects
education.field_of_study, business.industry, Population, General Medicine, Overweight, medicine.disease, Obesity, Primary health, medicine, medicine.symptom, education, business, Humanities, Body mass index, Developed country, Demography
Abstract

BACKGROUND AND OBJECTIVE Despite the number of plans leading to lose weight among individuals in the developed countries, the prevalence of obesity has increased since 1980. The knowledge of ponderal evolution in a given population is very important because the adverse effects of obesity vary greatly among individuals and populations. The objective of the present paper was to determine the modifications in the different degrees of body adiposity in a population in Catalunya. PATIENTS AND METHODS A measurement was made of weight and height of 24554 users aged over 14 years (10595 males and 13959 females) attended at four basic health areas (BHA): Girona 1, Girona 4, Salt and Camprodon, and a Primary Health Center (PHC) in the Girona province, for a five-year period, 1995-1999. The prevalence of the different degrees of obesity was compared with that obtained in a previous study with 6373 individuals during the 1986-1989 period (4,579 males and 1794 females). RESULTS The prevalence of women with overweight (defined as a body mass index [BMI] > 25 kg/m2) increased from 7.3% (1986-1989, study 0) to 17.6% (1995-1999, study 1) for women aged 15 to 24 years ( p 30 kg/m2) increased from 6.9% to 12.9%. Similar trends were observed among men, and the change in the 35-44 year age group (from 10.5 % of obese men to 16% [p < 0.001]), and 55 to 65 years (from 16.6% of obese men to 22.7% [p < 0.001] was particularly significant. And lastly, it is also noteworthy the proportion of individuals with low weight (BMI < 18.5 kg/m2) which increased from 7.3% to 11.6% for women aged 15 to 24 years, and from 0.3% to 2.2% for women aged 35 to 44 years. This trend was also observed for men aged 15 to 24 years (11% to 17.2%). CONCLUSIONS The relative increase in the prevalence of overweight and obesity runs in parallel to that found in other surrounding countries. Also, it is worth mentioning that among women aged 15 to 24 years the increase in the prevalence of low weight and obesity is almost identical, which invalidates the mean and median values as a means to assess the ponderal evolution in this population. The current compartmentalization between the extreme BMIs, particularly among the youngest portion of population should be addressed from a multidisciplinary perspective.

Published
2003
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13. Enfermedad aguda crítica e hiperglucemia

Author

W. Ricart

Subjects
Endocrinology, Endocrinology, Diabetes and Metabolism
Abstract

La hiperglucemia que aparece en el contexto de enfermedad critica de forma transitoria e independientemente de la presencia de diabetes mellitus, conocida como diabetes del estres, esta despertando un progresivo interes clinico. Existen evidencias clinicoepidemiologicas que relacionan la hiperglucemia con el pronostico de pacientes con diferentes enfermedades agudas y de pacientes ingresados en general. Estos hallazgos estan provocando que el facultativo clinico abandone su profunda apatia, no solo para diferenciar entre la diabetes y la hiperglucemia de estres, sino incluso para plantearse diferentes cuestiones, como si la hiperglucemia de estres tiene entidad propia o simplemente es un epifenomeno de la inflamacion, o si el hecho de que no sea una diabetes indica un tratamiento hipoglucemiante, o si este tratamiento debe ser conservador o agresivo. Se revisan los diferentes estudios epidemiologicos y el impacto sobre la supervivencia de los todavia escasos ensayos terapeuticos con insulina. Sobre la base de los conocimientos obtenidos en estos trabajos y en la experimentacion basica y clinica, se abre la posibilidad de que el mejor control glucemico puede mejorar la supervivencia. Aunque los beneficios y riesgos de la insulinizacion intensiva no estan de momento suficientemente definidos, todo parece apuntar hacia la obtencion de la normoglucemia y de la insulinizacion. Las intervenciones terapeuticas que mejoran el control metabolico en sujetos con una situacion grave son beneficiosas y con una buena relacion coste-efectividad. La deteccion y el tratamiento de los pacientes diabeticos son inexcusables, y la hiperglucemia de estres en un paciente critico no debe ser ignorada.

Published
2003
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14. Resistencia a la insulina relacionada con el hierro

Author

J.M. Fernández-Real and W. Ricart

Subjects
Endocrinology, Endocrinology, Diabetes and Metabolism
Abstract

El metabolismo del hierro se halla ultimamente ligado a la expresividad clinica de numerosas enfermedades sistemicas. La presencia de hierro tisular en exceso contribuye a producir y potenciar la lesion ocasionada por radicales libres y a modular la lesion inflamatoria, sobre todo a nivel hepatico. La importancia que este hierro de deposito posee sobre la afeccion sistemica de la aterosclerosis y la diabetes mellitus se ha empezado a conocer en los ultimos anos. En esta revision se intenta resumir el conocimiento acumulado en esta materia, haciendo especial hincapie en los aspectos terapeuticos. La flebotomia es sencilla y barata y con muy escasos efectos secundarios. A pesar de ello, todavia no se ha generalizado su uso ni en aquellos casos en los que la sobrecarga ferrica es evidente.

Published
2002
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16. The TNF-β Gene Nco I Polymorphism Is Not Associated with Hypertriglyceridemia or Insulin Resistance in Lean and Obese Subjects

Author

J M, Fernández-Real, C, Gutierrez, W, Ricart, R, Casamitjana, M, Broch, J, Vendrell, C, Richart, and W, Ricant

Subjects
Adult, Male, Heterozygote, medicine.medical_specialty, Very low-density lipoprotein, Biophysics, Locus (genetics), Biology, Biochemistry, Body Mass Index, chemistry.chemical_compound, Insulin resistance, Internal medicine, Diabetes mellitus, Electric Impedance, medicine, Humans, Obesity, Allele, Deoxyribonucleases, Type II Site-Specific, Lymphotoxin-alpha, Molecular Biology, Hypertriglyceridemia, Triglyceride, Homozygote, Cell Biology, Middle Aged, medicine.disease, Endocrinology, Diabetes Mellitus, Type 2, chemistry, Body Composition, Body Constitution, Female, Insulin Resistance, Body mass index, Polymorphism, Restriction Fragment Length
Abstract

Interindividual differences in TNF-alpha monocyte responses can be accounted for by genetic polymorphisms at the TNF-beta locus defined by the Nco I restriction enzyme. Higher triglyceride levels in non-insulin-dependent diabetic patients homozygous at the 10.5-kb fragment of the TNF-beta gene have been described. The aim of this study was to investigate whether the Ncol polymorphism of the TNF-beta gene influences the relationship between insulin resistance and triglyceride levels. Thirty-eight healthy volunteers were divided into two groups according to the absence [homozygous for class 1 allele (1/1), n=16] or presence of the class 2 allele [n=22; 19 heterozygous (1/2), and 3 homozygous (2/2)]. Both groups were comparable in sex, age, BMI, waist/hip ratio, fat mass and percentage of body fat as measured by bioelectric impedance, skinfold measurements, and blood pressure (all p>0.05). There were no differences in serum cholesterol (total, or HDL and VLDL fractions) or in total or VLDL triglycerides between the groups (all p>0.05). The insulin sensitivity index (Minimal Model method) was comparable for the two groups. In summary, the 10.5-kb homozygous genotype of the TNF-beta locus does not contribute to differences in triglyceride levels or insulin sensitivity among nondiabetic subjects.

Published
1997
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17. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author

H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. Garcia, S. Russell, H. Kellar-Wood, M. R. Tola, B. Ostermeyer, Ch. Tzekov, K. Sartor, E. B. Ringelstein, P. P. Gazzaniga, Paul Krack, H. Fidaner, H. Rico, T. Dbaiss, F. Alameda, E. Torchiana, L. Rumbach, I. Charques, J. M. Bogaard, C. D. Frith, L. J. Rappelle, R. Brenner, A. Joutel, K. Fuxe, G. HÄcker, M. J. Blaser, J. Valls-SolÇ, G. Ulm, M. Alberdi, A. Bock, F. W. Bertelsmann, U. Wieshmann, J. Visa, J. R. Lupski, D. D'Amico, L. M. P. Ramos, A. A. Vanderbark, R. Horn, M. Warmuth, Dietmar Kühne, Mark S. Palmer, C. Ehrenheim, E. Canga, S. Viola, O. Scarpino, P. Naldi, R. Almeida, A. A. Raymond, J. Gamez, Stephan Arnold, A. DiGiovanni, J. Dalmau, C. C. Chari, H. F. Beer, J. C. Koetsier, J. Iriarte, E. Yunis, J. Casadevall, E. Le Guern, E. Stenager, S. R. Benbadis, J. M. Warter, F. Burklin, I. Theodorou, L. Johannesen, G. A. Graveland, X. Leclerc, I. Vecchio, L. Ozelius, G. Nicoletti, R. K. Gherardi, E. Esperet, M. L. Delodovici, F. Cattin, F. Paiau, Giorgio Sacilotto, C. A. J. Broere, D. Chavdarov, J. P. Willmer, C. H. Hawkes, Th. Naegele, E. Ellie, E. Dartigues, M. J. Guardiola, S. Hesse, Z. Levic, Marco Rovaris, P. Saugeir-Veber, B. A. Yaqub, H. F. Durwen, R. Larumbe, J. Ballabrina, M. Sendtner, J. Röther, M. Horstink, C. Kluglein, M.P. Montesi, H. Apaydin, J. Montoya, E. Waubant, Ch. Verellen-Dunoulin, A. Nicolai, J. Lopez-Delval, R. Lemon, G. Cantinho, E. Granieri, A. Zeviani, Wolfgang H. Oertel, U. Ficola, V. Di Piero, V. Fragola, K. Sabev, M. V. Guitera, I. Turki, F. Bolgert, P. Ingrand, J. M. Gobernado, L. M. E. Grimaldi, S. Baybas, B. Eymard, Y. Rolland, Y. Robitaille, Ta. Pampols, P. J. Koehler, A. Carroacedo, J. Vilchez, S. Di Vittorio, I. R. Rise, T. Nagy, M. Kuffner, E. Palazzini, A. Ott, J. Pruim, T. X. Arbizu, E. Manetti, C. Cervera, S. Felber, G. Gursoy, J. Scholz, G. A. Buscaino, M. S. Chen, A. Pascual, J. Hazan, J. U. Gajda, J. G. Cea, G. Bottini, G. Damalik, F. Le Doze, G. Bonaldi, J. M. Hew, C. Messina, A. M. Kennedy, J. M. Carney, N. M. F. 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Brasic, W. Heide, I. Santilli, W. M. Korn, D. Selcuki, M. J. Barrett, D. Krieger, T. Leon, T. Houallah, M. Tournilhac, C. Nos, D. Chavot, F. Barbieri, F. J. Jimenez-Jimenez, J. Muruzabal, K. Poeck, A. Sennlaub, L. M. Iriarte, L. G. Lazzarino, C. Sanz, P. A. Fischer, S. D. Shorvon, R. Hoermann, F. Delecluse, M. Krams, O. Corabianu, F. H. Hochberg, Christopher J. Mathias, B. Debachy, C. M. Poser, L. Delodovici, A. Jimenez-Escrig, F. Baruzzi, F. Godenberg, D. Cucinotta, P. J. Garcia Ruiz, K. Maier-Hauff, P. R. Bar, R. Mezt, R. Jochens, S. Karakaneva, C. Roberti, E. Caballero, Joseph E. Parisi, M. Zamboni, T. Lacasa, B. Baklan, J. C. Gautier, J. A. Martinez-Matos, W. Pollmann, G. Thomas, L. Verze, E. Chleide, R. Alvarez Sala, I. Noel, E. Albuisson, O. Kastrup, S. I. Rapoport, H. J. Braune, H. Lörler, M. Le Merrer, A. Biraben, S. Soler, S. J. Taagholt, U. Meyding-Lamadé, K. Bleasdale-Barr, Isabella Moroni, Y. Campos, J. Matias-Guiu, G. Edan, M. G. Bousser, John B. Clark, J. Garcia de Yebenes, N. K. Olsen, P. Hitzenberger, S. Einius, Aj Thompson, Ch. J. Vecht, T. Crepin-Leblond, Klaus L. Leenders, A. Di Muzio, L. Georgieva, René Spiegel, K. Sabey, D. Ménégalli, J. Meulstee, U. Liszka, P. Giral, C. Sunol, J. M. Espadaler, A. D. Crockar, K. Varli, G. Giraud, P. J. Hülser, A. Benazzouz, A. Reggio, M. Salvatore, K. Genc, M. Kushnir, S. Barbieri, J. Ph. Azulay, M. Gianelli, N. Bathien, A. AlMemar, F. Hentati, I. Ragueneau, F. Chiarotti, R. C. F. Smits, A. K. Asbury, F. Lacruz, B. Muller, Alan J. Thompson, Gordon Smith, K. Schmidt, C. Daems Monpeun, Juergen Weber, A. Arboix, G. R. Fink, A. M. Cobo, M. Ait Kaci Ahmed, E. Gencheva, Israel-Biet, G. Schlaug, P. De Jonghe, Philip Scheltens, K. Toyka, P. Gonzalez-Porque, A. Cila, J. M. Fernandez, P. Augustin, J. Siclia, S. Medaglini, D. E. Ziogas, A. Feve, L. Kater, G. J. E. Rinkel, D. Leppert, Rüdiger J. Seitz, S. Ried, C. Turc-Carel, G. Smeyers, F. Godinho, M. Czygan, M. Rijntjes, E. Aversa, M. Frigo, Leif Østergaard, J. L. Munoz Blanco, A. Cruz-Matinez, J. De Reuck, C. Theillet, T. Barroso, V. Oikonen, Florence Lebert, M. Kilinc, C. Cordon-Cardon, G. Stoll, E. Thiery, F. Pulcinelli, J. Solski, M. Schmiegelow, L. J. Polman, P. Fernandez-Calle, C. Wikkelso, M. Ben Hamida, M. Laska, E. Kott, W. Sulkowski, C. Lucas, N. M. Bornstein, D. Schmitz, M. W. Lammers, A. de Louw, R. J. S. Wise, P. A. van Darn, C. Antozzi, P. Villanueva, P. H. E. Hilkens, C. Constantin, W. Ricart, A. Wolf, M. Gamba, P. Maguire, Alessandro Padovani, B. M. Patten, Marie Sarazin, H. Ackermann, L. Durelli, S. Timsit, Sebastian Jander, B. W. Scheithauer, G. Demir, J. P. Neau, P. Barbanti, A. Brand, N. AraÇ, V. Fischer-Gagnepain, R. Marchioli, G. Serratrice, C. Maugard-Louboutin, G. T. Spencer, D. Lücke, G. Mainardi, K. Harmant Van Rijckevorsel, G. B. Creel, R. Manzanares, Francesco Fortunato, A. May, J. Workman, K. Johkura, E. Fernandez, Carlo Colosimo, L. Calliauw, L. Bet, Félix F. Cruz-Sánchez, M. Dhib, H. Meinardi, F. Carrara, J. Kuehnen, C. Peiro, H. Lassmann, K. Skovgaard Olsen, A. McDonald, L. Sciulli, A. Cobo, A. Monticelli, B. Conrad, J. Bagunya, J. Benitez, V. Desnizza, B. Dupont, O. Delrieu, D. Moraes, J. J. Heimans, F. Garcia Rio, M. Matsumto, A. Fernandez, R. Nermni, R. Chalmers, M. J. Marchau, F. Aguado, P. Velupillai, P. J. Martin, P. Tassan, V. Demarin, A. Engelien, T. Gerriets, Comar, J. L. Carrasco, J. P. Pruvo, A. Lopez de Munain, D. Pavitt, J. Alarcon, Chris H. Polman, B. Guldin, N. Yeni, Hartmut Brückmann, N. Wilczak, H. Szwed, R. Causaran, G. Kyriazis, M. E. Westarp, M. Gasparini, N. Pecora, J. M. Roda, E. Lang, V. Scaioli, David R. Fish, D. Caputo, O. Gratzl, R. Mercelis, A. Perretti, G. Steimetz, I. Link, C. Rigoletto, A. Catafau, G. Lucotte, M. Buti, G. Fagiolari, A. Piqueras, C. Godinot, J. C. Meurice, Erodriguez J. Dominigo, F. Lionnet, H. Grzelec, David J. Brooks, P. M. G. Munro, F. X. Weilbach, M. Maiwald, W. Split, B. Widjaja-Cramer, V. Ozturk, J. Colas, E. Brizioli, J. Calleja, L. Publio, M. Desi, R. Soffietti, P. Cortinovis-Tourniaire, E. F. Gonano, G. Cavaletti, S. Uselli, K. Westerlind, H. Betuel, C. O. Dhiver, H. Guggenheim, M. Hamon, R. Fazio, P. Lehikoinen, A. Esser, B. Sadzot, G. Fink, Angelo Antonini, D. Bendahan, V. Di Carlo, G. Galardi, A. F. Boller, M. Aksenova, Del Fiore, V. de la Sayette, H. Chabriat, A. Nicoletti, A. Dilouya, M. L. Harpin, E. Rouillet, J. Stam, A. Wolters, M. R. Delgado, Eduardo Tolosa, G. Said, A. J. Lees, L. Rinaldi, A. Schulze-Bonhage, MA Ron, C. Lefebvre, E. W. Radü, R. Alvarez, M. L. Bots, P. Reganati, S. Palazzi, A. Poggi, N. J. Scolding, V. Sazdovitch, T. Moreau, E. Maes, M. A. Estelies, P. Petkova, Jose-Felix Marti-Masso, G De La Meilleure, N. Mullatti, M. Rodegher, N. C. Notermans, T. A. T. Warner, S. Aktan, J. P. Louboutin, L. Volpe, C. Scheidt, W. Aust, C. M. Wiles, U. Schneider, S. K. Braekken, W. R. Willems, K. Usuku, Peter M. Rothwell, C. Talamon, M. L. Sacchetti, A. Codina, M. H. Marion, A. Santoro, J. Roda, A. Bordoni, D. J. Taylor, S. Ertas, H. H. Emmen, J. Vichez, V. BesanÇon, R. E. Passingham, M. L. Malosio, A. Vérier, M. Bamberg, A. W. Hansen, E. Mostacero, G. Gaudriault, Marie Vidailhet, B. Birebent, K. Strijckmans, F. Giannini, T. Kammer, I. Araujo, J. Nowicki, E. Nikolov, A. Hutzelmann, R. Gherardi, J. Verroust, L. Austoni, A. Scheller, A. Vazquez, S. Matheron, H. Holthausen, J. M. Gerard, M. Bataillard, S. Dethy, V. H. Patterson, V. Ivanez, N. P. Hirsch, F. Ozer, M. Sutter, C. Jacomet, M. Mora, Bruno Colombo, A. Sarropoulos, T. H. Papapetropoulos, M. Schwarz, D. S. Dinner, N. Acarin, B. Iandolo, J. O. Riis, P. R. J. Barnes, F. Taroni, J. Kazenwadel, L. Torre, A. Lugaresi, I. L. Henriques, S. Pauli, S. Alfonso, Pedro Quesada, A. S. T. Planting, J. M. Castilla, Thomas Gasser, M. Van der Linden, A. Alfaro, E. Nobile-Orazio, G. Popova, W. Vaalburg, F. G. A. van der Mech, L. Williams, F. Medina, J. P. Vernant, J. Yaouanq, B. Storch-Hagenlocher, A. Potemkowski, R. Riva, M. H. Mahagne, M. Ozturk, Ve. Drory, N. Konic, C. Jungreis, A. Pou Serradell, J. L. Gauvrit, G. J. Chelune, S. Hermandez, T. Dingus, L. Hewer, Ch. Koch, M. N. Metz-Lutz, G. Parlato, M. Sinaki, Charles Pierrot-Deseilligny, H. C. Diener, J. Broeckx, J. Weill-Fulazza, M. L. Villar, M. Rizzo, O. Ganslandt, C. Duran, N. A. Fletcher, G. Di Giovacchino, Susan T. Iannaccone, C. Kolig, N. Fabre, H. A. Crockard, Rita Bella, M. Tazir, E. Papagiannuli, K. Overgaard, Emma Ciafaloni, I. Lorenzetti, F. Viader, P. A. H. Millac, I. Montiel, L. H. Visser, M. Palomar, P. L. Murgia, H. Pedersen, Rafael Blesa, S. Seddigh, W. O. Renier, I. Lemahieu, H. M. L. Jansen, L. Rosin, J. Galofre, K. Mattos, M. Pondal, G. M. Hadjigeorgiou, D. Francis, L. Cantin, D. Stegeman, M. Rango, A. B. M. F. Karim, S. Schraff, B. Castellotti, I. Iriarte, E. Laborde, T. J. Tjan, R. Mutani, D. Toni, B. Bergaasco, J. G. Young, C. Klotzsch, A. Zincone, X. Ducrocq, M. Uchuya, O. J. Kolar, A. Quattrone, T. Bauermann, Nereo Bresolin, J. Vallée, B. C. Jacobs, A. Campos, Werner Poewe, J. A. Villanueva, A. W. Kornhuber, A. Malafosse, E. Diez-Tejedor, G. Jungreia, M. J. A. Puchner, A. Komiyama, O. Saribas, V. Volpini, L. Geremia, S. Bressi, A. Nibbio, Timothy E. Bates, T. z. Tzonev, E. Ideman, G. A. Damlacik, G. Martino, G. Crepaldi, T. Martino, Kjell Någren, E. Idiman, D. Samuel, J. M. Perez Trullen, Y. van der Graaf, J. O. Thorell, M. J. M. Dupuis, E. Sieber, R. D'Alessandro, C. Cazzaniga, J. Faiss, A. Tanguy, A. Schick, I. Hoksergen, A. Cardozo, R. Shakarishvili, G. K. Wennlng, J. L. Marti-Vilalta, J. Weissenbach, I. L. Simone, Amalia C. Bruni, Darius J. Adams, C. Weiller, A. Pietrangeli, F. Croria, C. Vigo-Pelfrey, Patricia Limousin, A. Ducros, G. Conti, O. Lindvall, E. Richter, M. Zuffi, A. Nappo, T. Riise, J. Wijdenes, M. J. Fernandez, J. Rosell, P. Vermersh, S. Servidei, M. S. C. Verdugo, F. Gouttiere, W. Solbach, M. Malbezin, I. S. Watanabe, A. Tumac, W. I. McDonald, D. A. Butterfield, P. P. Costa, F. deRino, F. Bamonti, J. M. Cesar, C. H. Lahoz, I. Mosely, M. Starck, M. H. Lemaitre, K. M. Stephan, S. Tex, R. Bokonjic, I. Mollee, L. Pastena, M. Gutierrez, F. Boiler, M. C. Martinez-Para, M. Velicogna, O. Obuz, A. Grinspan, M. Guarino, L. M. Cartier, E. Ruiz, D. Gambi, S. Messina, M. Villa, Michael G. Hanna, J. Valk, Leone Pascual, M. Clanet, Z. Argov, B. Ryniewicz, E. Magni, B. Berlanga, K. S. Wong, C. Gellera, C. Prevost, F. Gonzalez-Huix, R. Petraroli, J. E. G. Benedikz, I. Kojder, C. Bommelaer, L. Perusse, M. R. Bangioanni, Guy M. McKhann, A. Molina, C. Fresquet, E. Sindern, Florence Pasquier, M. J. Rosas, M. Altieri, O. Simoncini, M. Koutroumanidis, C. A. F. Tulleken, M. Dary-Auriol, S. Oueslati, H. Kruyer, I. Nishisho, C. R. Horning, A. Vital, G. V. Czettritz, J. Ph. Neau, B. Mihout, A. Ameri, M. Francis, S. Quasthoff, D. Taussig, S. Blunt, P. Valentin, C. Y. Gao, O. Heinzlef, H. d'Allens, C. Coudero, M. Erfas, G. Borghero, P. J. Modrego Pardo, M. C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg

Subjects
Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published
1994
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18. Incidence of Type 1 (insulin-dependent) diabetes mellitus in Catalonia, Spain

Author

A. Goday, C. Castell, R. Tresserras, J. Canela, J. L. Taberner, G. Lloveras, E. Aguadé, J. M. Albarran, X. Allué, M. Aliart, J. Anglada, J. Arroyo, M. Bergua, J. M. Calvet, J. F. Cano, R. Carrasco, A. Carrascosa, R. Clivillé, R. Corrales, B. Costa, M. Estruch, A. Famades, A. Felip, M. Fernandez-Castañer, D. Figuerola, X. Freixas, F. Gallo, A. Garcia-Rico, R. Gomis, A. Guarro, M. Gussinyé, A. Gutierrez, G. Hollenberg, L. Ibañez, F. Iniesta, A. de Leiva, T. Lezaun, J. Lopez Batllori, J. Marco, A. Martinez-Roig, I. Martinez, J. R. Masoliver, D. Mauricio, J. Mayos, M. T. Mengotti, J. Mesa, T. Micaló, M. Millan, E. Montaña, R. Nosas, A. Novials, A. Nubiola, M. Olesti, A. Palaudaries, C. Pavia, A. Perez, C. Perez, J. M. Pla, M. Porta, G. Prat, M. Prat, J. Querol, H. O. Rajmil, I. Recas, J. L. Reverter, W. Ricart, L. Riu, J. Rodriguez-Hierro, M. Roqueta, R. Rosell, M. D. Salcedo, A. Sanmarti, T. Sansa, J. M. Sans-Mallafré, P. Sardá, A. Sarto, J. Soler, M. Soler, E. Subiracs, R. Torras, P. Utges, J. Vendrell, E. Vicens-Calvet, J. Vidal-Bota, J. Viguera, L. Vila, M. Vila, E. Vilardell, C. Vilaseca, D. Yeste, and V. Yetano

Subjects
Type 1 diabetes, medicine.medical_specialty, education.field_of_study, business.industry, Endocrinology, Diabetes and Metabolism, Incidence (epidemiology), Population, medicine.disease, Confidence interval, Endocrinology, Internal medicine, Diabetes mellitus, Epidemiology, Internal Medicine, Medicine, Young adult, business, education, Prospective cohort study, Demography
Abstract

The incidence of Type 1 (insulin-dependent) diabetes mellitus was prospectively evaluated in Catalonia, Spain in patients up to 30 years of age during the period 1987–1990. The population at risk (0–29 years) consisted of 2,690,394 inhabitants (total population of Catalonia 5,978,638). All the cases were independently identified from four sources: endocrinologists, sales of blood glucose monitors and insulin pen injectors, diabetes societies and diabetic summer camps. The degree of ascertainment was 90.1 %. The overall observed incidence rate was 10.7 per 100,000 per year, being 11.5 per 100,000 per year in the 0–14 age group. The incidence in males (12.0 per 100,000 per year) was higher than in females (9.3 per 100,000 per year), with a male/female ratio of 1.36/l. The sex differences were only present in cases over 14 years of age. Age specific incidence rates per 100,000 per year were 4.4 (confidence interval 95%: 3.2–5.7) in the age group 0–4, 9.9 (8.5–11.4) in 5–9, 17.5 (15.7–19.4) in 10–14, 11.4 (9.9–13.0) in 15–19, 11.3 (9.7–13.0) in 20–24 and 8.5 (7.2–9.9) in 25–29. There was a seasonal onset pattern, with the highest incidence in winter (December–February). We conclude that the incidence of Type 1 diabetes observed in Catalonia during the period 1987–1990 is higher than that recently reported in other Mediterranean countries. This study offers the first standardized data on Type 1 diabetes incidence in Catalonia, including cases up to 30 years, and contributes to the knowledge of the epidemiology of diabetes in South Europe.

Published
1992
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19. Cost of severe hypoglycaemia in patients with type 1 diabetes in Spain and the cost-effectiveness of insulin lispro compared with regular human insulin in preventing severe hypoglycaemia

Author

J, Reviriego, R, Gomis, J P, Marañés, W, Ricart, P, Hudson, and J A, Sacristán

Subjects
Adult, Male, Insulin Lispro, Adolescent, Cost-Benefit Analysis, Health Care Costs, Middle Aged, Drug Costs, Hypoglycemia, Young Adult, Endocrinology & Metabolism, Diabetes Mellitus, Type 1, Spain, Humans, Hypoglycemic Agents, Insulin, Female, Health Services Research, health care economics and organizations, Retrospective Studies
Abstract

Objectives To determine the costs of severe hypoglycaemia (SH) in a population of patients with type 1 diabetes mellitus in the Spanish healthcare system and the cost-effectiveness of insulin lispro over regular insulin in preventing SH episodes. Methods A retrospective study of 100 patients in three Spanish health centres was performed. Resource utilisation data were collected only for interventions specifically relating to the hypoglycaemic episode. The direct medical costs determined in the analyses were: costs of hospitalisation, diagnostic tests carried out, costs of treatment administered and other associated costs such as visits to the endocrinologist and re-training in glucose control, transportation and assistance of a care-giver. In addition, indirect costs such as days of lost productivity were measured. The incidence rates of SH for insulin lispro and regular insulin were obtained from the literature. The incremental cost-effectiveness of insulin lispro over regular insulin was calculated. Results The overall mean cost per episode of SH was €366, comprised of 65.4% direct costs and 35.6% indirect costs. The largest cost was for hospitalisation at €183 per episode. The SH episodes incidence rates for 100 patients per year were 33 and 73 for insulin lispro and 48 (p < 0.05) and 117 (p < 0.01) for regular insulin, in the two clinical trials found in the literature. The additional cost to prevent one episode of SH with insulin lispro over regular insulin ranged from €277 to insulin lispro dominance. Conclusions Severe hypoglycaemia has a significant impact on the total cost of diabetes. The use of insulin lispro is associated with reductions in annual costs because of SH and, possibly, the overall effect may be cost neutral or cost saving when total costs are considered. The cost of SH should be included in the analysis of total socio-economic burden of diabetes. Disclosures J. Reviriego and J. Sacristan are currently employees of Lilly Spain. Dr Gomis, Dr Marañes and Dr Ricart have served as consultant and speakers in Lilly medical educational and scientific meetings. In addition all authors at some point have been involved as investigators in Lilly registration trials. What's known Little or none data were available with respect to the costs of acute diabetes-related complications associated with insulin treatment as is the case for severe hypoglycaemia. What's new We provide valuable information on the impact of therapeutic alternatives such as the use of an insulin analogue (insulin lispro) vs. regular human insulin on the total cost of diabetes.

Published
2008

20. Prevalence of diabetic retinopathy in the region of Girona: Study of related factors

Author

W Ricart, R Valent Ferrer, J M Fernández-Real, C Teruel Maicas, and M Vallés Prats

Subjects
Gynecology, Related factors, education.field_of_study, medicine.medical_specialty, Epidemiologic study, Retinopatia diabetica, diabetes, business.industry, Population, Estudio transversal, prevalence, prevalencia, Diabetic retinopathy, medicine.disease, Ophthalmology, Retinopatía diabética, Medicine, Statistical analysis, epidemiology, business, education, Retinopathy, epidemiología
Abstract

espanolObjetivo: Determinacion de la prevalencia de la retinopatia diabetica en la poblacion general de diabeticos en las comarcas de Girona y estudio epidemiologico de los factores asociados. Metodo: Estudio transversal de base poblacional en una muestra aleatoria de 401 pacientes diabeticos diagnosticados en las comarcas de Girona. Analisis estadistico descriptivo de las lesiones oculares en relacion con la retinopatia diabetica y analisis de regresion logistica para determinacion de los factores de riesgo de la retinopatia. Resultados: El 30,6% (IC 95%: 26,5-35,5) de la muestra presento algun grado de retinopatia diabetica. En estadio inicial el 19,4% (IC 95%: 15,4-24,0), preproliferante el 8,4% (IC 95%: 5,8-1,9) y proliferante el 2,6% (IC 95%: 1,3-5,1). Por tipo de diabetes, el 53,8% de los diabeticos de tipo 1 presentaban retinopatia frente al 34,2% entre los de tipo 2. Se observo retinopatia en un 15,7% de los diabeticos de menos de 10 anos de evolucion de la diabetes, 51,3% entre 10 y 20 anos y 62,8% en mas de 20 anos. La concentracion de HbA1C presento una correlacion significativa con el grado de retinopatia. De los pacientes con retinopatia, el 60,3% recibian tratamiento con insulina, 30,6% con antidiabeticos orales y 10,3% unicamente con dieta. Se encontro mayor prevalencia de retinopatia entre los diabeticos con antecedentes familiares de la misma. Conclusiones: Un tercio de la muestra ha presentado algun grado de retinopatia en este estudio de pacientes diabeticos con base poblacional aleatoria. La prevalencia fue mayor entre los diabeticos de tipo 1. De los factores de riesgo estudiados, el tiempo de evolucion de la enfermedad, el tipo de tratamiento de la diabetes y el grado de control metabolico fueron los factores mas involucrados en la presencia de retinopatia. EnglishPurpose: To determine of the prevalence of diabetic retinopathy in the general diabetic population in the Girona region and epidemiologic study of the related factors. Methods: A population-based cross-sectional study of a randomised sample taken of 401 diabetics in the Girona region. Descriptive statistical analysis of the ocular lesions in relation to diabetic retinopathy and analysis of logistic regression in order to determine the related factors. Results: 30.6% (IC 95%: 26.5-35.5) of the sample presented some degree of diabetic retinopathy, 19.4% (IC 95%: 15.4-24.0) at the initial stage, 8.4% (IC 95%: 5.8-1.9) pre-proliferative and 2.6% (IC 95%: 1.3-5.1) at a proliferative stage. Regarding the type of diabetes, 53% of the patients with type 1 diabetes and 34.2% of those with type 2 diabetes had retinopathy. Retinopathy was observed in 15.7% of diabetics with less than 10 years of diabetes evolution, 51.3% in those between 10 and 20 years and 62.8% in those with more than 20 years. The concentration of HbA1C was significantly associated with the degree of retinopathy. Of those patients with retinopathy, 60.3% were insulin-treated, 30.6% with oral hypoglucemiants and 10.3% on diet only. Patients with family antecedents of retinopathy presented a prevalence three times greater than those without. Conclusions: Approximately one in three diabetic patients exhibited some degree of retinopathy in this study dealing with a population-based cohort of diabetic patients in Spain. The prevalence was greater among type I diabetic patients. As expected, years of evolution of the disease, type of treatment and diabetic metabolic control were the most significant factors influencing the presence of retinopathy.

Published
2005

21. [Obesity and inflammation]

Author

M, Recasens, W, Ricart, and J M, Fernández-Real

Subjects
Inflammation, Metabolic Syndrome, Arteriosclerosis, Interleukin-6, Tumor Necrosis Factor-alpha, Proteins, Models, Biological, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Hypertension, Adipocytes, Animals, Cytokines, Humans, Intercellular Signaling Peptides and Proteins, Adiponectin, Obesity, Insulin Resistance
Abstract

The adipose tissue produces a vast number of molecules called adipokines such as leptin, tumoral necrosis factor (TNFalpha), interleukins and adiponectin. Many of the metabolic disturbances associated with obesity and the metabolic syndrome may be due to citokine production by adipocytes. The adipose tissue increases the soluble fractions of TNFalpha leading to a rise in its biological activity. The activation of TNFalpha system causes insulin resistance through different mechanisms such as defects in receptor fosforilation and reduction in insulin-sensitive glucose transporters. TNFalpha is also involved in the pathophysiology of hypertension and dyslipidaemia associated with obesity and insulin resistance. More than one third of interleukin-6 (IL-6) concentrations come from the adipocytes. It has been demonstrated a role for IL-6 in the development of hyperlipidemia, diabetes and hypertension. In contrast to the rest of adipokines, adiponectin is reduced in obesity, diabetes or cardiovascular disease. Adiponectin improves insulin resistance, dyslipidaemia and adhesion to endothelial cells protecting from atherosclerosis development. Thus, adipokines have an important role in the pathophysiology of metabolic syndrome by different mechanisms involving metabolic and vascular effects.

Published
2004

22. 40(th) EASD Annual Meeting of the European Association for the Study of Diabetes : Munich, Germany, 5-9 September 2004

Author

S. Artigas, A V Dreval, Mark I. McCarthy, C Watson, Peter H. Bennett, M Quint, Y Ikeda, E Alpert, F Schiele, H Sekihara, Erik Gylfe, P Lowe, J Kuhlmann, Alain Golay, V Longo, Shahidul Alam Khan Akm., L G Mantovani, M Zawodniak-Szalapska, G Winkler, T Harrity, L Virág, U Johne, Kuo S-W., Linda C Tapsell, J Rodriguez, Michel Komajda, K Kankova, Carole A. Cull, M Sporna, E Estilles, U Ribel, M C Spruce, E Buzzigoli, T Prazak, J K McLaughlin, M K Lingohr, M Lim, F Calara, A Siebenhofer, G Meregalli, Roberto Anichini, A D Baron, R Kurashvili, P C Butler, G I Fantus, T. E. De Gooyer, Park Y-M., R. Walther, S Heinrich, Agnieszka Zawiejska, S Mukherjee, Nikolaos Papanas, G Wong, Ian D. Caterson, David M. Maahs, Shuichi Kaneko, Alexandra E. Butler, Francisco Javier Ampudia-Blasco, O N Kong, Attali J-R., C A Hedman, K Oshinyemi, Nicolle Müller, I C Cranston, N Okumus, M V Vlaiculescu, Balasubramanian Ravikumar, W W Cheatham, K Mukasa, K B Biswas, Annunziata Lapolla, Phil McEwan, G Mader, Gilles Chassot, Dragi Anevski, Werner A. Scherbaum, M Donath, C Hesselmann, R A Gandhi, David E. Moller, Ezio Bonifacio, C Garcia, V Ifandi, P Hornnes, Nieuwenhoven Fav., C Puech, S Pérez-Del-Pulgar, Kim S-R., G Hines, C Rubio Terrés, Michael Gaster, N. Hosszufalusi, A Scholze, Andrew A. Young, Stavros Liatis, F Hariri, S Tan, Paul Valensi, Allan E. Karlsen, J Kim, E. Moberg, J Kaiser, L Berman, G Nelson, A Altkrüger, P Kothare, D B Cook, S Doran, G. van Dijk, Shahnaz Shahinfar, Kim C-S., P Stahl, M Manousaki, S Sigrist, S K Lim, M. P. Stern, A Guberti, C Rezzani, J McKenney, Karl Thomaseth, Sofia Carlsson, M Julia, R Brillante, I Rubesova, T Darkow, E Matsumoto, Wendy M. Macfarlane, M Di Martino, G Bardini, Rossella Menghini, D Duhot, E Farcasiu, Annalisa Natalicchio, I Lindner, J Buvat, Christian L. Brand, Harry Dorchy, Iwona Pietrzak, Z T Luo, P Home, M Ekelund, Jesper Gromada, Kristine Færch, F Piarulli, H Kim, R Mentel, Zsuzsanna K. Zsengellér, Dullaart Rpf., Anton Luger, Thomas A. Pearson, V Manicardi, P Rösen, Feng Y-M., R Morganti, Lars Hansen, Demuth H-U., Haruo Kasai, A Shostak, Rudi Steffensen, G Taylor, Markolf Hanefeld, C Santini, E Hamaguchi, Roberto Miccoli, F Storms, M Cooper, Y Lee, Allison E. Aiello, P Smith, T Suehiro, K Treece, M Waluś, Timothy A Welborn, Simone Baltrusch, E Kontela, S Chai, J Crean, H Yokoyama, Johan G. Eriksson, Rafael Hernández Hernández, J Rodríguez-Saldaña, M P Tornero, G Formoso, D. Lovell, E Bingham, A Mylonakis, M Manteghetti, D Fedele, Antonio Martín-Duce, Ralph A. DeFronzo, D Salcedo, Kurt Højlund, Antonio Petrone, Sheu Whh., C Gutierrez, Flavia Pricci, S Kurita, Z G Abbas, M M Benedetti, Philippe A. Halban, Daniel J. Cox, O Ljungkvist, Justine Davies, J Palsgaard, Lars Sjöström, E Bosi, L Janin-Manificat, W. F. Kelly, M. Fernandez, E Colak, O V Mulyarchik, B Kronshage, F Lang, M Erfurth, Takashi Kadowaki, N Jendrike, U Walter, J Wishart, Y. Neye, D Kim, N Furuhashi, M Barsotti, D Florow, L Ke, L Borgquist, N C Jackson, Ffolliott M. Fisher, V Baskar, K Yoshioka, Bryan A. Wolf, G Chabrier, R Skoumal, Livio Luzi, H Kose, I Pharisien, B. Klein, H Winiarska, M C Johnson, L Griffiths, Nonna Kravchun, C Combe, Baptist Gallwitz, J Zdychova, L Skorda, Jorma Ilonen, W Gao, I N Steen, A Terrinoni, P D Ambery, W Kern, C M Kusminski, Cho M-H., Paolo Pozzilli, Louise G. Grunnet, E Schönle, David R Matthews, Robert W. Taylor, Y Cohen, Kim H-S., M P Eccles, N B Tutuncu, D McDowell, Richard M. Bergenstal, K Takamatsu, T Steiner, Jaan Palgi, Valdemar Grill, N Niculescu, G Federici, S Lehto, P. M. McKeigue, M Barone, Michael E. Trautmann, S Smirnov, J Mannion, M Eto, C Rousseau, M Conti, C S Ernest, Antonio Ceriello, D H Schweitzer, Jung E-D., Andreas Festa, Avijit Lahiri, A Shepelkevich, A Murro, A Kollmann, Jonathan R.S. Arch, R Landgraf, Son H-Y., I Engelsberger, E Agardh, S Rodríguez-Mulero, P J Kraml, K Lee, D. F. Du Toit, E Kim, G Fadini, Williams Ajk., Philip Home, M B Antcieferov, C Perlemoine, D Perrea, Song X-L., D Ruggieri, Krister Bokvist, Heidi Sørensen, Bilbao, G Yoshino, J P Taylor, Shen H-M., S M Furier, R Urquhart, J Wohlgelernter, Jianping Weng, T. Baba, Q Hong, C Silva, Castaigne J-P., M Felaco, X X Zhang, M Jaroň, Milla Rosengård-Bärlund, J G Papp, Toshio Miyata, Lervang H-H., Park M-K., I Kinalska, A Long, Oomen Phn., N Kogawa, Ippolita Patrizia Patera, S. Karadeniz, Dinesh Selvarajah, D S Chung, A Wensaas, Richard Imrich, M Recasens, J Ruxer, O Buchea, E Wilpart, S P Stepanenko, Le Ttd., H Ohgawara, Mariaconsuelo Valentini, A Mondok, M Peltonen, Marianne O. Larsen, K Chatzianagnostou, Agneta Ståhle, A L Ferrari, L Bordier, F Maingrette, A Matsuda, G Vukomanovic, Jakob D. Wikstrom, T Yamakita, E Gorostiaga, J Jin, B Gopalan, Heinz Drexel, S Hewitt, Rury R. Holman, C Dieterle, T L Ruchti, N Asatiani, M Sidira, A Iezzi, A J Sommerfield, D Châtenet, M L Olsen, R Bergemann, C Koehler, T L Kuraeva, B Balas, Christian Berne, E Santos-Mazo, G Smith, A Siejka, R Kožnarová, A Mattina, S Sheikh, A Adomeit, M Rasmussen, J. Fagerudd, N Busciantella Ricci, Nuria Vilarrasa, E Hammar, T L Thoms, L Aydın, Ron G. Rosenfeld, A Nikolajuk, R Gos, C L Morgan, H L Yu, D Dheelchand, S Ramrath, N Boudriga, Jerome I. Rotter, C Jahannault, W M Weston, Folke Lindgärde, M Hertlova, D Knight, A Monroy-Mayorga, E Pardini, A Chamson-Reig, B Franke, Janie McCluskey, Joseph Bryan, C Nikolopoulou, Christie M. Ballantyne, Fausto Santeusanio, L Pegoraro, M Lee, A Klimenko, S Jaiveer, K. Pettersson-Fernholm, Michael A. Nauck, A Ekbom-Schnell, G Deferrari, Riccardo Schiaffini, S. Pampanelli, Khan Aka., David Hopkins, Maija Wessman, M Kamarinos, Noh J-H., O Ebisui, K McCarroll, Jeppe Sturis, Peter Nowotny, N Gorbenko, Åke Sjöholm, David G. Maggs, A E Halseth, B Cresci, A A Ortiz-Gress, A Korakovouni, O Matejkova, C E Mogensen, C J Lin, Ramon Gomis, H Seaman, C Granier, Yang C-H., F Assah, O Sanchez, Fausto Machicao, Peter G. Morris, Alberto Ortiz, A Giardinelli, D Bracaglia, A Gonzalo, S Pavlatos, Andreas Lechner, F Canovic, L Sjolind, Allan Vaag, Birgitte Bruun Nielsen, David A. Ziegler, Vito Lampasona, R Gershoni-Baruch, A. Dei Cas, H Renz, E Mena, Matthew Waltham, Kim D-M., H Levanen, D D Mick, Valentina Alexandrovna Peterkova, E Meskhishvili, Sarah Nutland, R Bustani, John R. Lindsay, M Christoforidou, A Abicht, E Harno, K Cyganek, A Fitchet, S Neelotpol, P Nikishin, P Serradas, J Hinrichsen, M Halvorson, M Chovatia, B Voet, Jinny Willis, E Parretti, M Haslbeck, M Wellard, L Teng, Julio Wainstein, J S Fischer, K. Lalic, D Roggenland, I Gich, R Anwar, Maurizio Cassader, D Serota, X J Li, R J Schotzinger, Vilmundur Gudnason, Björn Zethelius, S A Wootton, W Andrzejewski, R Rezsohazy, R Gao, T Klimentova, T Mazurek, I Bruckner, C Dohrmann, R E James, G daSilva Xavier, Kim S-Y., A Dorca, Stuart J. Pocock, Terri J. Allen, I Giovos, P B Parab, N H Andersen, P Fotinakis, Miriam Cnop, H Lee, Norbert Tennagels, Omorodola I. Abatan, F Ailett, I. Lager, D Manzella, H Hut, Larry A. Distiller, G Lip, Lim S-K., Rong Zhang, T Tsuno, Steen Knudsen, M. Bajardi, Manuel Benito, Dai Sugimoto, Melvin J. Prince, D W Dunstan, D Rankins, K A Majali, G Ozansoy, Isabella Russo, S Uçak, G Annuzzi, R Talar-Wojnarowska, K Lange, S Neugebauer-Baba, Campbell H. Thompson, Eric Renard, P. D. Mountjoy, Z Morrison, Elizabeth A. Davis, Franco Cavallo, C Corvaja, R Antuña, Craig John Currie, H Linnebjerg, He Y-L., A J Palmer, Mariola R. Chacón, H Malinska, M. Jones, R Lichnovská, K Mandes, Paolo Tessari, T Mokhort, A Laina, H. L. Y. Chan, I Schmidt, R Banks, Richard G. IJzerman, L Ksinantova, G Setti, H Vaudry, A Gallo, V Spallone, Chen J-W., Thomas Danne, A Chong, M Hallschmid, S Aczel, S Hulme, N Islam, M Hosoi, P M Ternan, P Di Bartolo, N Bishara, T Shibasaki, Martin A. Osterhoff, Im S-S., M Jecht, T Hamaguchi, S Mattera, K Ways, Elizabeth Northam, U Rajala, Reinhard W. Holl, L Yang, S Panaiotopoulos, K Horvath, R Kluge, Thora B. Bodvarsdottir, Y Dong, Irene Alemanno, C McDougall, Reimar W. Thomsen, M Campbell, W Rabl, John Öhrvik, Yuichiro Yamada, Paola Ungaro, W Benzer, Mike Sampson, Roberto Trevisan, R G Radu, Aas A-M., P E Lobo, Ricardo Scott, S M Son, Josephine M. Forbes, T A Hillier, K L Wyne, Louis L. Nguyen, J Farmer, M H Tan, Kwon H-S., J Yang, L Sandvik, Franco Folli, A K Jenum, M Nguyen, W Pratipanawatr, A L Frederiksen, Rebecca Smith, Lee H-J., A Schäfer, C Manuelli, G S Denver, T Vukovich, B Maceira, K Matsumoto, K. Chokkalingam, Nurcan Üçeyler, P Modi, Timothy M. Morgan, S Mertens, B M Singh, Michaela Riedl, K Iso, C Cucurullo, G. F. Bottazzo, M Calvani, K Hur, J Wetzels, Kazuhiro Takahashi, Y Aso, H Stammer, M G Masding, Fitsum Guebre-Egziabher, J L González-Sánchez, L Armstrong, Alberto Maran, Peter G.F. Swift, S S Popovic, J Starczynski, E Vitacolonna, Luigi Laviola, R W Gelling, Marina Cardellini, D Barilla, Rosa de Diego Martínez, W H Landschulz, Anne Mette Rosenfalck, R K Wong, Kevin E. Schneider, K Peros, Giuseppe Nanni, F Zhang, I Rákóczi, T Iburi, M Nakhjavani, X Q Zhang, S Tournis, Per Lav Madsen, Graham A. Hitman, A. Tura, K Laubner, N D Kostic, Lawrence M. Dolan, R. Sinha Roy, J A Wagner, J. Tuomilehto, J Hauptman, M Abdel-Ghany, D Lacombe, Toralph Ruge, Johannes A Maassen, Triantafyllos Didangelos, K Sasaki, I Argüelles, Klaus Levin, C Popow, Emanuel Christ, R Chetty, L Baillet-Blanco, Jo-Ann Salmon, T Mine, James L. Trevaskis, I Franke, J Gorski, E A Andrianova, A Dayan, A Caballero, Aleksandra Gilis-Januszewska, M Yasujima, Z Kasalová, C.D.A. Stehouwer, F. K. Gorus, G A Nichols, A Glowania, David P. Strachan, P Fredlund, N. F. da Silva, P Reboldi, M Sausbier, K H Groenier, G Stuccio, N Guttman, K R Ahmed, A D Ristic, T Kapellen, J Coutcher, Aldo V. Greco, Oswald Wagner, A Zagayko, Maria Alevizaki, B B Zhang, W F Ferris, Jenny Fredriksson, Lois Jovanovic, J Hänninen, R De Giglio, Kazuo Yagui, O Potterat, P Hamliton, R E Scranton, B Mankovsky, A Stylianou, B Fellström, Abdel-Wahab Yha., M Kitagawa, Katherine L. Baldock, F R Johnson, F Baigts, S D'Addato, F J Sanz, A Mistry, S D Wise, T Pratipanawatr, U R Fölsch, James R.C. Parkinson, Claudia Sommer, C Park, F E Griffiths, M L Martí, R Demirtunc, S Taniguchi, J Lundkvist, T Siegmund, Juan Sztajzel, C Dienesch, F Baumgartner, L Scalone, T M Mckolanis, K Otake, Ullrik Pedersen-Bjergaard, T M Vriesendorp, Michael B. Wheeler, Henry Schmitt, Peter Hovind, S Lange, Stephane Roze, L. Van Gaal, B Klaproth, Anthony E. Civitarese, D Eckland, A Dagar, D F Hopkins, Kari Stefansson, C Gonzalez-Yanes, B Meyboom-de Jong, D. J. Betteridge, K Buhling, M Crepaldi, Ana M. Wägner, L Renna, L Volpe, R McBride, V Corbo, E O Brennesvik, R P Hayes, R Abdollahnia, G Viviani, C F Liew, Francisco Pérez-Bravo, Jeffrey Baron, Brian M. Frier, H H Samira, D Szentendrei, K. J. Schjoedt, W K Waldhäusl, D Gniuli, D Zou, G Tschank, V Urbančič, A L Nolan, Albertini J-P., J Malcomson, M Larbig, C Cheyssac, K Aurich, C M Kesson, S Heller, Maija E. Miettinen, R F Luco, Adrian J. Cameron, Luigi Mattiello, Z. Metelko, X E Zhang, M Parramón, I. G. Obrosova, J Fruchart, M Ilic, Björn Eliasson, Gilles Chatellier, M A Martín, D M Kendall, Holger Luthman, V F Varillas, D Maccubbin, Jang S-A., Amalia Gastaldelli, E Salzsieder, P. de Mol, A Yoshida, H D Lindner, D Gostiljac, M Just, Pan C-Y., J M Fujitaki, G Eiermann, K Bergenheim, A D Frick, A Agacdiken, K Varytimiadis, K Cseh, D A Jackson, S Calderari, Dena G. Hernandez, H M Liebich, K Min, F. de Zegher, Bernd Kulzer, K Han, Ulrich A. Müller, D Marrero, H Hatakeyama, René Koopman, Doo H-K., Petr Wohl, P. Sharp, P Forder, Thor Aspelund, N Meneveau, R M Schmülling, R Aubert, Thom Sam., H Youshikawa, M Ankelo, D Bowden, I Kelly, Frédéric Fumeron, M Sartini, Robert S. Sherwin, L Varadhan, A Criscimanna, John Betteridge, V Jelic, M Bartnik, N Lemke, B Ursø, A Bertoldo, A M Owona, H Okochi, L Pérez-Tamajó, S L Monfre, Daniel Brandhorst, K T Legg, Andries J. Smit, Veronica Sancho, Masashi Hirai, C Klein, Paul J. Thornalley, A Chaidaroglou, K Miura, B Zinman, O M Dvoynishnikova, J Plank, Jan Bolinder, C Lush, B Rubi, R Pozzilli, M Bashir, S A Shtandel, F Mosca, A Naskalska, Josef Vcelak, U Sausbier, P Cavaiani, T U Baehring, Michele Solimena, P Formisano, M Rastaldi, Bernard Thorens, J Ruzzin, E Arbit, M. Hori, Torkel B. Brismar, E Soltes Rak, A Filo, P Heinke, Matthew P. Coghlan, M Masotti, I Perevozskaya, K Ahn, I Moules, K Van Dyck, I Goldstein, Z Mathe, G Z Zhao, S Fajardo, J Taylor, S Chrul, J C Pareja, D Hadjidakis, A J Scheen, N Siddiqua, D C Cavan, R Grella, Krabbe S, H J Rochlitz, A E Hinkkanen, W Wilpshaar, Richard Stevens, M Dreyer, S Hara, X Wang, Melania Manco, D Gillen, Magalie A. Ravier, Olli Simell, John C. Lawrence, Kohnert K-D., Agardh C-D., A Berghold, L Kristensen, Grant Sfa., N Gursoy, Leif Groop, N Freemantle, Anja Schweizer, L Pala, Legros J-J., C. Di Pietro, N. Yamamoto, J Magyar, B Nikolovski, H Ikeda, D Lee, Bruce A. Buckingham, A O Wollitzer, I Kennedy, C Ernest, Neville H. McClenaghan, S Tanaka, Asimina Mitrakou, T Heinze, W Kerner, Moeenaldeen Al-Sayed, Charles Thivolet, L Klaff, A Miconi, Cristina Valeri, J. O. Christensen, K. Ekberg, A Jardine, T Endo, X Zhang, D F Child, A Kienitz, D K Seidel, H. Tada, Sylvie Abouna, Cyrus Cooper, Catherine R Chittleborough, Roberta Assaloni, S Corbi, A K Bose, K Ozawa, C Ahn, K A Deans, G Jackowski, Martin Gibson, Patrick McElduff, O A Mojiminiyi, Manuel Serrano-Ríos, O Dupuy, A L Davydov, Iwar Klimes, Sten-Anders Ivarsson, N Ichino, R Matsutomo, E R Smith, A Stefanovska, B Dehmel, K Koniavitou, E Agascioglu, M Hatazaki, J. M. Gibson, T Yada, P Ribaux, M Rupnik, K Fridell, G Scutaru, L Chugunova, Henrietta Mulnier, A Kendereski, H Lehnert, C Billi, M Sobczak, Francisco M-Mj., L K Archibald, S Sukumvanich, David B. Dunger, I. Benke, G Yillar, N Stingemore, J. M. Boavida, Y Shi, Jimmy D. Bell, L Bozzetto, Andrew J. Ahmann, E Jebens, J Keiding, Elena Henkel, Mark Fineman, J F McRae, Carol Forsblom, S Martemucci, Lourdes Ibáñez, P G Prieto, L Ringholm Nielsen, S Pratas, B von Stritzky, Julio Rosenstock, Lee K-W., J Stocks, L J Strow, I Samarguliani, L Wennekes, R Cheung, Abhishek Nag, Roberto Gambino, Y Suleymanoglu, E Murphy, T T Durck, M F Peyrot, Y Unno, Alexander Mayorov, Eleuterio Ferrannini, D. C. Rao, D Neely, H Karunajeewa, J Palmisano, Julia B. Lewis, M Ravid, G Pons, E Junca, P Vexiau, S Sailesh, D K Miloslavskiy, O N Bondarenko, U Smith, S Torri, Constantine Tsigos, Cesario Bianchi, Mattia Locatelli, D Jaquet, Virpi Lindi, M Moroi, M E Tushuizen, P Pelicci, R Scognamiglio, Pal Pacher, S M Thyssen, A Péterfalvi, Y Ho, S Guntram, L Romics, T Nakagami, Clive S. Cockram, Irina Kowalska, K Brodbeck, Gojka Roglic, J. Dörig, Lise Tarnow, Therese Tillin, A López-Alba, Martin Krššák, Moses Elisaf, S Hata, D P Snoeck, D Schmoll, O V Udovichenko, A Scaramuzza, J Paul, John H. Fuller, Nicholas Katsilambros, Michele Muggeo, Pia Ekbom, Piero Marchetti, V Melki, C Bailleau, H Stavrianos, A D'Errico, Geremia B. Bolli, Amabile Maier, Kelter A-R., Anders Green, Q J Morélis, Steffen Thiel, C Watkins, R C Cheung, A Clark, Elvira Fioriti, N Ari, Nam J-Y., Y Cottin, L G Krinelke, H Al Mohammedi, Simon C. Fleming, C Jones, Z Kerényi, Ahn Y-H., Meile M-J., P Nánási, M Graner, V Canonico, Gangnerau M-N., Hugh R. Taylor, Giovanni Sartore, A. Dejgaard, Carol Kelley, S. Ali, Stéphane Dalle, Jeffrey S. Gonzalez, Elena Šeböková, Alexander Beck, Ingo B. Leibiger, M Rosu, C Pencea, Werner Waldhäusl, Kaltenbacher M-C., R Butzer, S Thore, Adam G. Tabak, Angelo Avogaro, E Standi, Boris Kovatchev, O Bradescu, Patrizia Dentelli, A Fujita, C Verri, R Chlup, Prasad Ydm., S V Hörsten, van der Merwe M-T., D Hilliard, W Klein, D Worthley, M Udvardy, Berit R. Jensen, A D'Avanzo, J Monaghan, K P Yeo, Guivarch P-H., B Bauduceau, D Weghuber, P Tatti, J Ybarra, S Gwozdziewiczová, E Gasparini, B Saltin, Charlotte Granhall, Howard Leventhal, R Marin, M Tumiati, Cicero Afg., L Csémy, B Berger, S Mikros, D Dall'Asta, M Shahmanesh, Y G Vasiljev, F Potthoff, H S Randeva, G De Berardis, J O Logan, K Warncke, P Uitterlinden, E Rehring, K Gilmore, K Shankhdhar, V V Bojko, M Vahatalo, E A Korolyova, D Wiemann, P G Lankisch, D Hendrie, F Galtier, M Rybarczyk, Gisela Dahlquist, N N Rudovich, G Stein, A Liebl, F Tan, A Westerlund, S Gronemann, I Franklin, Jonathan A. Prince, Peter Arner, E Skliros, T. Sparre, M Vigas, Maddalena Trombetta, L. Bjerre Knudsen, A C Sima, I Dubroca, Alastair Gray, I Weets, R Ferraresi, Schauer Ujw., E. Leinonen, S Corazza, Jonathan Levy, P K Prakash, R Guzder, S. Barnhill, John Blangero, J Herreros, G. de Vries, Cheng Ptw., A Macías-Batista, K. Capito, R Thomas, G Thomas, G Boemi, Lotte Pietraszek, Pierre Fontaine, I Holme, J Smedegaard, C A Harrop, U Helwig, B Levy, A P Gribben, Hiroto Furuta, P Beckett, S Giannini, Ruth L. Coleman, Eva Fernqvist-Forbes, N Cugnardey, A Dumas, Jane Pinaire, S E Hofer, D Shimono, Erik H. Serné, Alain D. Baron, C Battista, M Tanen, M Klementova, V Adams, J Komorowski, Antonio Nicolucci, E. C. Burns, H Sydall, M G Fanara, M G Giovannitti, N Okabayashi, Magdalena Szurkowska, I A Eroshkin, M. I. J. Uusitupa, D Ma, C C Dieguez, J Sutcliffe-Goulden, A V Gaddi, Michał Arabski, Serge Halimi, Wendy C. Burns, S Seclén, H Sugano, A Vinterby, K Backx, L F Diaconu, Fernando Gomez-Peralta, O'Harte Fpm., G Lepeniotis, D Laune, H Kvasničková, N H Wallén, G Boner, G Cieślik, Robert Hermann, Paul Q. Thomas, Y Kumon, Maria Maiello, M Atkins, Kenneth A. Earle, Guowang Xu, H Y Bae, I Reynisdottir, D Perez, D E Cannon, P Fabietti, I Geronooz, J Østergaard, K J Jeitler, S Skourtis, A Zambanini, A Saemann, K Kuboki, Helen L. Lutgers, A C Thai, Arne Melander, D Pinkowski, S G Straub, S A Wolfe-Coote, A Totora, Hayley Dickinson, A Lindenmair, A Ginis, I Faturos, F Van Eylen, C Huard, F Fu, N Wang, B M Rasmussen, Angela Napoli, L Granato, Markus M. Lerch, M. Frandsen, A Lyras, Lawrence S. Phillips, J Mabley, R Goldschmeding, B K Kilhovd, W Liu, Greg Poffenberger, P Cipriano, Anna Maria Charlotte K Lindqvist, A Matsuzawa, J Wang, T Yu, M S Pepper, Lena M. Thorn, Y Sakamoto, Blanche Schwappach, Anna L. Gloyn, P Dupraz, A. M. Schmidt, M Psallas, V Tsirimbis, Carl D. Langefeld, D Sass, H E Scholtz, M. Cailleau, Lauren Julia Brown, K Phillips, M. Iezzi, C Jayawarna, Eleni Anastasiou, R Lobmann, R Lundershausen, H Fujiwara, H R Nan, I C Smith, I A Karpova, A Navazio, S Kang, T. Hansen, T Watanabe, Gang Hu, Malik Rja., T Kennedy-Martin, Ulla M Smidt, J.M. Dekker, A A Fisher, H Liu, R E Pratley, B Sun, C Fledelius, J F Raposo, R Langham, Ahn S-Y., B R Waterhouse, Shaoping Deng, W Ricart, S V Melnichenko, Henrike Sell, M. Tomalino, N Takeda, Paola Massucco, A Harlan, W Henrich, C D Byrne, R Junik, Khalid Hussain, D Pop Gorceva, Torben Hansen, C Ritterath, K Ogawa, D V Phan, Bradley S Metcalf, Robb E. Moses, Juan P. Frias, Hitoshi Ishii, C Brisard, P Wolkow, H H Maurer, Ingo Rustenbeck, Juris J. Meier, Octavian Savu, S D Lin, V B Bregovski, A Fox, S Cicala, M. Koenen, L Vignati, O de Divitiis, Constantin Ionescu-Tirgoviste, Kilian Rittig, J Song, Riccardo Candido, F Cohen-Boulakia, U Shankhdhar, P Jahan, Antonio Tiengo, E Liepinsh, C Álvarez, Sigurd Lenzen, James E. Foley, A. del Arco, M A Maitan, U Mollenhauer, M A Na, A Beha, B Aicher, Gabriele Meyer, E Sommariva, J Åman, B Gmeinhart, Theede A-M., Bjorn Bolinder, Giulio Ceolotto, S Sbrana, F Biarnes, Damini Dey, Barbara Thorand, H H Klein, Juliana C.N. Chan, L Piconi, S Gudbjornsdottir, E Bobbioni-Harsch, Joanna Polanska, Cristian Serafinceanu, S Gambardella, Olivier Huber, J D Brunzell, T Nagasawa, Loretta Vileikyte, A Szocs, H Löwel, Z Lin, Anders Juul, H Tsuneki, L Sauriol, G Siebert, Marit E. Jørgensen, K Matthies, Brian D. Green, P Jurowski, Z Gao, M Furuya, Silvia Manfrini, Efthymios Motakis, E Souvatzoglou, Qian Y-Z., Byun S-H., T Nguyen, M R Anwar, Geltrude Mingrone, B. Idzior-Walus, Mamas A. Mamas, G Scholl-Schilling, C Bittner, A E Raptis, L Laghi, Murray Stewart, M Orel, Janet M. 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Dell'Antonio, G, Maestroni, A, Ruggieri, D, Luzi, L, Piemonti, L, Zerbini, G, Anafaroglu, I, Tutuncu, N, Sultana, M, Siddiqua, N, Iwasaki, T, Nakajima, A, Yoneda, M, Mukasa, K, Tanaka, S, and Sekihara, H

Subjects
0303 health sciences, medicine.medical_specialty, business.industry, EASD, Endocrinology, Diabetes and Metabolism, Human physiology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Family medicine, Internal Medicine, Medicine, business, 030217 neurology & neurosurgery, 030304 developmental biology
Published
2004

23. [Ponderal evolution in the Girona population, 1989-1999]

Author

J M, Fernández-Real, M, Sáez, J M, García-Rafanell, A, Marqués, D, Serrà, R, Girona, C, Viñets, M, Andreu, P, Badosa, D, Faixedas, M, Faixedas, J M, Garrido, M, Gómez-Matai, M, Torra, M A, Barceló, C, Saurina, and W, Ricart

Subjects
Adult, Male, Age Distribution, Adolescent, Spain, Body Weight, Prevalence, Humans, Female, Obesity, Middle Aged, Sex Distribution, Aged
Abstract

Despite the number of plans leading to lose weight among individuals in the developed countries, the prevalence of obesity has increased since 1980. The knowledge of ponderal evolution in a given population is very important because the adverse effects of obesity vary greatly among individuals and populations. The objective of the present paper was to determine the modifications in the different degrees of body adiposity in a population in Catalunya.A measurement was made of weight and height of 24554 users aged over 14 years (10595 males and 13959 females) attended at four basic health areas (BHA): Girona 1, Girona 4, Salt and Camprodon, and a Primary Health Center (PHC) in the Girona province, for a five-year period, 1995-1999. The prevalence of the different degrees of obesity was compared with that obtained in a previous study with 6373 individuals during the 1986-1989 period (4,579 males and 1794 females).The prevalence of women with overweight (defined as a body mass index [BMI]25 kg/m2) increased from 7.3% (1986-1989, study 0) to 17.6% (1995-1999, study 1) for women aged 15 to 24 years ( p0.001), from 17.9 % to 28.1% for women aged 25 to 34 years (p0.001), and from 37.5% to 44.7 % for women aged 35 to 44 years (p0.001). In the latter age group, the proportion of women with obesity (BMI30 kg/m2) increased from 6.9% to 12.9%. Similar trends were observed among men, and the change in the 35-44 year age group (from 10.5 % of obese men to 16% [p0.001]), and 55 to 65 years (from 16.6% of obese men to 22.7% [p0.001] was particularly significant. And lastly, it is also noteworthy the proportion of individuals with low weight (BMI18.5 kg/m2) which increased from 7.3% to 11.6% for women aged 15 to 24 years, and from 0.3% to 2.2% for women aged 35 to 44 years. This trend was also observed for men aged 15 to 24 years (11% to 17.2%).The relative increase in the prevalence of overweight and obesity runs in parallel to that found in other surrounding countries. Also, it is worth mentioning that among women aged 15 to 24 years the increase in the prevalence of low weight and obesity is almost identical, which invalidates the mean and median values as a means to assess the ponderal evolution in this population. The current compartmentalization between the extreme BMIs, particularly among the youngest portion of population should be addressed from a multidisciplinary perspective.

Published
2003

24. [Insulin resistance and its involvement in multiple risk factors associated with type 2 diabetes mellitus]

Author

M, Serrano Rios, J F, Ascaso Gimilio, E, Blázquez Fernández, J, Cabezas Cerraro, R, Carmena Rodríguez, F, Escobar Jiménez, J M, Fernández-Real, R, Gabriel Sánchez, R, Gomis de Barberá, C, Grande Aragón, J L, Herrera Pomba, L F, Pallardo Sánchez, N, Potau Vilalta, W, Ricart Engel, A, Rovira Loscos, and A, Zorzano Olarte

Subjects
Adult, Hypertriglyceridemia, Male, Hypercholesterolemia, Hyperlipidemias, Middle Aged, Metformin, Europe, Diabetes Mellitus, Type 2, Risk Factors, Spain, Albuminuria, Humans, Hypoglycemic Agents, Female, Obesity, Insulin Resistance
Published
2002

26. [Body mass index (BMI) and percent fat mass. A BMI27.5 kg/m2 could be indicative of obesity in the Spanish population]

Author

J M, Fernández-Real, M, Vayreda, R, Casamitjana, M, Saez, and W, Ricart

Subjects
Adult, Male, Adipose Tissue, Spain, Humans, Nutritional Status, Female, Obesity, Prospective Studies, Sex Distribution, Body Mass Index
Abstract

The World Health Organization (WHO) defines obesity as a condition of excessive fat accumulation to the extent that health and well-being are affected. For population studies, the measurement of weight, corrected for height, is still the method of choice (BMI). In Caucasian populations, the BMI cut-off point for obesity (30 kg/m2) corresponds with a percent body fat (PFM) of over 25% in young adult males and 35% in young adult females. However, the relation between BMI and PFM is not uniform among populations. It is important to define in each population the threshold of BMI which corresponds to the definition of obesity.BMI was calculated in 282 subjects. PFM was analyzed using Bio-electrical impedance. Blood pressure, serum glucose and insulin, and the fasting insulin resistance index were also determined in all subjects to analyze the metabolic impact.The PFM of 25% in males and 35% in females corresponded to a BMI of 27.5 and 27.4 kg/m2, respectively. The slope of the relationship between the degree of obesity and comorbilities (insulinemia, fasting insulin resistance index and blood pressure) was strengthened above 26 kg/m2 in men and 24 kg/m2 in women.BMI that corresponds to a PFM previously defined as obesity is lower in our population in comparison with other Caucasian populations. Our results confirm that is impossible to compare the prevalence of obesity among populations using exclusively the BMI. It will be important to define, using reference methods, whether these findings have physiological impact or not, and if this cut-off of BMI determines an increment in cardiovascular and overall mortality using epidemiological approaches.

Published
2001

27. [Insulin secretion and insulin sensitivity in relation to glucose tolerance in a group of subjects at a high risk for type 2 diabetes mellitus]

Author

I, Conget, J M, Fernández Real, Costa A, R, Casamitjana, and W, Ricart

Subjects
Adult, Male, Diabetes Mellitus, Type 2, Risk Factors, Humans, Insulin, Female, Glucose Tolerance Test
Abstract

Oral glucose tolerance test was evaluated, as well as, insulin sensitivity/secretion in a group of subjects at risk for type 2 diabetes mellitus.Metabolic profile of subjects included in the new category, impaired fasting glucose (IFG), was also evaluated.IFG and impaired glucose tolerance identify different alterations in glucose homeostasis.Those subjects with IFG are heterogeneous in their oral glucose tolerance. They display defects not only in insulin sensitivity but also in their capacity to compensate for it.

Published
2001

28. [Analysis of mutations A3243G, C3256T and mitochondrial deletions in 41 diabetic patients]

Author

J, Biarnésa, I, Rojas, M, Fernández-Castañer, V, Nunes, M, Gómez, and W, Ricart

Subjects
Adult, Male, Time Factors, Hearing Loss, Sensorineural, Middle Aged, DNA, Mitochondrial, Polymerase Chain Reaction, Body Mass Index, Diabetes Mellitus, Type 2, Diabetes Mellitus, Humans, Point Mutation, Electrophoresis, Polyacrylamide Gel, Female, Gene Deletion
Abstract

Mutations or deletions of mitochondrial DNA (mtDNA) define a new diabetes subtype.The A3243G and C3256T mutations and mtDNA deletions were studied in 41 diabetic patients with maternally inherited diabetes mellitus or deafness.The A3243G mutation was found in one out of forty-one diabetic patients (2.4%). Neither the C3256T mutation nor mtDNA deletions were detected.The search of A3243G mutation has to be considered in a diabetic patient with deafness and/or maternal history of diabetes.

Published
2001

29. [Prevalence of obesity in the population assisted at primary health care services in Girona, 1995-1999]

Author

M, Sáez, J, García-Rafanell, J, Fernández-Real, M, Barceló, C, Saurina, A, Marqués, D, Serrà, R, Girona, C, Viñets, M, Andreu, P, Badosa, D, Faixedas, M, Faixedas, J, Garrido, M, Gómez-Mata, M, Torra, and W, Ricart

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Primary Health Care, Spain, Prevalence, Humans, Female, Obesity, Middle Aged, Aged
Abstract

To estimate the prevalence of obesity and overweight in the population of Girona (Spain) between 1995 and 1999 and to divide the prevalences in geographical areas according to age and sex.Height and weight were directly measures in 24,554 health care consumers older than 14 years (10,595 men and 13,959 women) treated in four primary health care areas: Girona 1, Girona 4, Salt and Camprodon and in one primary health care center in the province of Girona. Body mas index (BMI) was calcuted by dividing weight in kilograms bye height in meters squared. Obesity was defined as grades II and III of Garrow's index (BMI= 30 kg/m2) and overweight as degree I (25 kg/m2= BMI30 kg/m2). Because the sample was not randomized, the prevalences were adequately weighted. The comparison between prevalences in two different primary health care areas for each sex (in the same Garrow's index and age group) was carried out using a parametric test of differences in proportions (Student's t-test). A hierarchical logistic regression was used to compare prevalences in the same grade Garrow's index, controlling for age and sex.The prevalence of obesity was estimated as 15.6% in men aged from 20-74 years (from 14.0% in Girona 1 to 22.4% in Camprodon) and 17.5% for women (15.6% in Girona 1, 22.7% in Camprodon). The weighted mean was 16.7%. The prevalence of overweight was 44% in men and 33% in women and the weighted mean was 37.8%. The prevalence of obesity was graduated with statistically significant differences between Girona 1, Salt, Girona 4, Camprodon and Sils.The estimates of the prevalences of obesity and overweight obtained in this study were closer to those of other studies in similar populations than previously believed. Indeed, the prevalences may be similar to those of the European Union and, in some age groups, to those of the United States.

Published
2001

30. [An increased proinflammatory activity is inherent in insulin resistance]

Author

J M, Fernández-Real and W, Ricart

Subjects
Adult, Male, Genotype, Gene Expression, Mice, Obese, Diabetes Mellitus, Experimental, Islets of Langerhans, Mice, Adipocytes, Animals, Humans, Insulin, Obesity, Cells, Cultured, Inflammation, Mice, Knockout, Polymorphism, Genetic, Interleukin-6, Tumor Necrosis Factor-alpha, Lipid Metabolism, Adipose Tissue, Diabetes Mellitus, Type 2, Liver, Mutation, Carbohydrate Metabolism, Female, Inflammation Mediators, Insulin Resistance
Published
2000

31. [Adipsia and hypernatremia as the first manifestation of hypothalamic astrocytoma. Report of a case and review of the literature]

Author

C, Porcar Ramells, J M, Fernández-Real Lemos, M, Camafort Babkoski, and W, Ricart Engel

Subjects
Male, Hypernatremia, Drinking, Humans, Astrocytoma, Hypothalamic Neoplasms, Middle Aged
Abstract

Adipsia and hypernatremia is a syndrome which can be observed among children and adults with various congenital or acquired diseases of the brain. We can include the primary neoplasms and the metastatic among the causes of this syndrome. We display the case of a 63-year-old man who presented time-space disorientation, loss of memory fixation, visual hallucinations, unstable walking and absence of the voluntary ingestion of liquids. The serum electrolytes showed serum sodium concentration of 188 mEq/l with plasma osmolality above 380 mOs/kg. Both the forced water intake and the intravenous rehydration restored the plasma osmolality and the normal levels of serum sodium. The magnetic resonance (MR) neurohypophyseal area showed a neoformative lesion at the middle line which affected septum ventricular and hypothalamic area. We analyse the pathophysiologic mechanisms, the clinical and laboratory data, as well as the therapeutic and the evolution of the cases which have been published in the literature.

Published
2000

32. Insulin sensitivity and secretion influence the relationship between growth hormone-binding-protein and leptin

Author

J M, Fernandez-Real, M L, Granada, A, Ruzafa, R, Casamitjana, and W, Ricart

Subjects
Adult, Leptin, Male, Glucose Tolerance Test, Glucose Intolerance, Insulin Secretion, Chromatography, Gel, Linear Models, Body Constitution, Humans, Insulin, Female, Obesity, Prospective Studies, Carrier Proteins, Chromatography, High Pressure Liquid
Abstract

A direct relationship between body mass index (BMI), visceral adipose tissue, insulin levels and growth hormone-binding protein (GHBP) activity has consistently been reported. It was recently described that GHBP directly depends on serum leptin levels. Since leptin co-varies with insulin secretion and/or sensitivity, we aimed to study the influence of these variables on plasma GHBP activity.In order to isolate the effects of obesity per se from those of insulin secretion, three groups of subjects were prospectively studied: 14 lean, 10 obese and nine obese subjects with glucose intolerance.The percentage of body fat was measured through bioelectric impedance. Insulin sensitivity and secretion were determined through a frequently sampled intravenous glucose tolerance test with minimal model analysis. Serum leptin was measured by radioimmunoassay. GHBP activity was determined by the high performance liquid chromatography-gel filtration method.Plasma GHBP activity was found to correlate with BMI (r = 0. 65, P0.0001), fat mass (r = 0.51, P = 0.003), waist circumference (r = 0.64, P0.0001), waist-to-hip ratio (r = 0.42, P = 0.01), insulin sensitivity (SI, r = - 0.61, P = 0.0001), insulin secretion (expressed as the acute insulin response to intravenous glucose, AIRg) (r = 0.48, P = 0.006) and leptin concentration (r = 0.49, P = 0.004). The associations with SI (r = - 0.42, P = 0.02) and AIRg (r = 0.38, P = 0.03) persisted even after controlling for fat mass. Since insulin secretion and insulin sensitivity usually covary in glucose tolerant subjects (an increased insulin secretion is necessary to compensate a decreased insulin sensitivity), we constructed a multiple linear regression to predict GHBP activity. In this model, SI (P = 0.005), AIRg (P = 0.02) and SD score-leptin (P = 0.03) independently contributed to 34, 10 and 8% of the variability in serum GHBP activity.Our results suggest that plasma GHBP activity is simultaneouslly influenced by insulin secretion and sensitivity and leptin. Perhaps leptin, through increased insulin secretion, might induce GHBP/GH secretion, explaining the normal to high insulin-like growth factor (IGF)-I levels found in overnutrition.

Published
2000

33. The insulin resistance syndrome and the binding capacity of cortisol binding globulin (CBG) in men and women

Author

J M, Fernández-Real, M, Grasa, R, Casamitjana, and W, Ricart

Subjects
Adult, Blood Glucose, Male, Hydrocortisone, Fatty Acids, Nonesterified, Glucose Tolerance Test, Lipoproteins, VLDL, Area Under Curve, Linear Models, Humans, Insulin, Female, Insulin Resistance, Carrier Proteins, Triglycerides, Protein Binding
Abstract

Both insulin resistance and cortisol binding globulin (CBG) capacity have been found to correlate with plasma free fatty acid (FFA) concentration.To examine the changes in CBG binding with varying degrees of insulin resistance and plasma FFA levels.Anthropometric parameters, serum cortisol levels, plasma CBG, CBG binding and insulin sensitivity (using the frequently sampled intravenous glucose tolerance test with minimal model analysis) were measured in a group of 38 healthy subjects (19 men, mean age 36.2 +/- 1.9; body mass index (BMI) 28.8 +/- 1.2, range 22.2-35.7), and 19 women, age 34.9 +/- 1.4; BMI 28.1 +/- 0.8, range 19-37.9)].Plasma CBG levels did not differ between men and women. In men, CBG binding was associated with several parameters of the insulin resistance syndrome, including area under the curve for glucose during an oral glucose tolerance test (MBG, r = 0.45, P = 0.04), fasting insulin (r = 0.66, P = 0. 002), plasma triglycerides (r = 0.75, P0.0001), VLDL-triglycerides (r = 0.59, P = 0.007), fasting FFA (r = 0.72, P = 0.002), uric acid (r = 0.57 (P = 0.01) and insulin sensitivity (SI, r = - 0.58, P = 0.008). Free cortisol (estimated as the ratio of cortisol to CBG) was not associated with waist-to-hip ratio (WHR) or parameters of insulin sensitivity. In contrast to men, CBG binding was not associated with MBG, fasting insulin, plasma triglycerides, VLDL-triglycerides, FFA, uric acid or SI (all P = NS) in women. Serum free cortisol, however, correlated positively with WHR (r = 0. 62, P = 0.02) and negatively with SI (r = - 0.68, P = 0.01) in obese women. A multiple linear regression to predict CBG binding was constructed, with plasma CBG concentration and insulin sensitivity as independent variables. In this model, only SI entered the equation at a statistically significant level (P = 0.0012) contributing to 52% of the variance in CBG binding in men. When plasma FFA levels were added to the model, both SI (P = 0.04) and FFA levels (P = 0.039) contributed to 66% of the variance of CBG binding in men. In women, both plasma CBG concentration (P = 0.0005) and insulin sensitivity (P = 0.047) entered the equation at a statistically significant level, contributing to 60% of the variance in CBG binding. When plasma FFA levels were added to the model, only plasma CBG concentration (P = 0.043) was found to significantly contribute to 38% of the variance in CBG binding. The latter finding suggests that FFA levels constituted a confounding variable in the association between SI and CBG binding in women.Both plasma free fatty acid and insulin sensitivity influence cortisol binding globulin binding capacity in men. Whether cortisol binding globulin binding is a factor implicated in the pathophysiology of insulin resistance or represents an adaptative tool in this situation awaits further studies.

Published
2000

34. [Impact of a selective screening for gestational diabetes in a Spanish population]

Author

W, Ricart, C, Bach, J M, Fernández-Real, J, Biarnés, and J, Sabrià

Subjects
Adult, Family Health, Diabetes, Gestational, Pregnancy, Risk Factors, Spain, Age Factors, Confidence Intervals, Prevalence, Humans, Female, Prospective Studies, Body Mass Index
Abstract

Recently, the American Diabetes Association (ADA) concluded that pregnant women with low risk factors for gestational diabetes need not to be tested. The aims of this study was to determine the prevalence of gestational diabetes in a Spanish low risk pregnant women population, to analyze the criteria that define low risk pregnancies for gestational diabetes, and to compare the differences in morbidity between pregnant women with and without gestational diabetes.Cohort study of 2,262 gestations (2,085 Caucasians) during a period of 7 years in a reference hospital.The gestational diabetes prevalence was 15%. Two-hundred and seventy-four (12.1%) women were considered as a low risk group for gestational diabetes. Among these, 13 (4.7%) presented gestational diabetes in comparison with 16.6% in the remaining women (p = 0.0001). Gestational diabetes in the low risk pregnant women constituted the 3.8% of all gestational diabetes. We did not find differences in gestational outcomes or fetal antropometry between the groups. The relative risk of macrosomia in the low risk pregnant was 0.9% (95% confidence interval for the mean: 0.86-0.94).In spite of their capacity of identifying current complications, 4% of gestational diabetes would not have been diagnosed with the new ADA criteria. The misdiagnosis will prevent in this small group of women the adoption of preventive measures for subsequent pregnancies and for diabetes in later life.

Published
1999

35. Plasma oestrone-fatty acid ester levels are correlated with body fat mass in humans

Author

J M, Fernández-Real, D, Sanchis, W, Ricart, R, Casamitjana, F, Balada, X, Remesar, and M, Alemany

Subjects
Adult, Leptin, Male, Analysis of Variance, Estrone, Fatty Acids, Proteins, Esters, Glucose Tolerance Test, Sensitivity and Specificity, Body Mass Index, Skinfold Thickness, Adipose Tissue, Body Composition, Humans, Insulin, Regression Analysis, Female, Triglycerides
Abstract

The metabolites of steroidal hormones, including sulphate, glucuronide, and fatty acid (FA) ester derivatives, have received little attention, although these steroid derivatives are essential components in the global assessment of steroid metabolism. The study of FA-derivatives could, in obesity, contribute some insights into factors modulating steroid metabolism and their plasma levels. In a recent study we found that, in rats, an oestrone-fatty acid ester (E1-FA) was produced by white adipose tissue and released into lipoproteins in the blood-stream. We have examined whether E1-FA levels correlate with body fat and insulin sensitivity in humans.A sample of 20 men and 22 women with varying levels of total body fat (mean body mass index (BMI) 29.2 +/- 4.7, range 22.2-35.8 in men; mean BMI 27.6 +/- 6.3, range 16.8-37.9 in women). All participants were healthy.We measured oestrone fatty acid esters (E1-FA), body fatness, and body fat distribution variables, as well as insulin sensitivity through a frequently sampled intravenous glucose tolerance test. Plasma E1-FA and serum leptin levels were measured by radioimmunoassay.E1-FA levels strongly correlated with BMI (r = 0.69, P = 0.001 in men; r = 0.75, P0.0001, in women) percent body fat (PBF, r = 0.52. P = 0.018 in men; and r = 0.69, P0.0001, in women) and with the sum of 4 fat skinfolds (sigma skinfolds). E1-FA level was significantly and positively associated with fasting insulin (r = 0.62, P = 0.003 in men, and r = 0.48, P = 0.023 in women) but not with fasting glucose levels. E1-FA correlated with insulin sensitivity (SI, r = -0.72 in men; and -0.76, in women, both P0.0001). In men, E1-FA levels also correlated with systolic blood pressure (r = 0.59, P = 0.01), total triglycerides (r = 0.63, P = 0.003), VLDL-triglycerides (r = 0.62, P = 0.004) and VLDL-cholesterol (r = 0.48, P = 0.03), but not with diastolic blood pressure, serum total or LDL-cholesterol, or total and HDL2 and HDL3 subfractions of HDL cholesterol. After controlling for fat mass, only the correlation between VLDL-triglycerides and E1-FA levels remained significant. In women, E1-FA levels correlated with total triglycerides (r = 0.66, P = 0.001), VLDL-triglycerides (r = 0.65, P = 0.001), VLDL-cholesterol (r = 0.63, P = 0.002), LDL-cholesterol (r = 0.57, P = 0.005) and total and HDL2 and HDL3 subfractions of HDL cholesterol (r = -0.58, -0.48, -0.61, P = 0.004, 0.02 and 0.002, respectively), but not with systolic or diastolic blood pressure or total cholesterol. However, covariance analysis revealed that controlling for the concomitant variation in body fat mass eliminated all these associations. Fasting plasma E1-FA concentration correlated with serum leptin (r = 0.60, P = 0.005 in men; r = 0.75, P = 0.0001, in women). However, these correlations no longer persisted after controlling for fat mass (r = 0.33 and 0.36, P = NS). Stepwise regression analysis models were tested, with E1-FA as the dependent variable, and sigma skinfolds and SI as independent covariables. Both the sigma skinfolds (P = 0.03) and SI (P = 0.01) entered the equation at a statistically significant level in men. Therefore, insulin sensitivity was related to E1-FA independently of fat in men. In women only sigma skinfolds (P = 0.04) entered the regression model at a statistically significantly level. Fifty-seven percent of the variance in plasma E1-FA levels in men, and 50% in women, was accounted for using a regression model that combined these variables.Oestrone-fatty acid esters circulate in human blood in proportion to body fat, independently of gender. Plasma oestrone-fatty acid ester levels are associated with insulin sensitivity in men, independently of body fat. These findings may widen our perspective on the regulation of insulin action and control of body weight.

Published
1999

36. [Insulin secretion in women and insulin sensitivity in men constitute independent determinants of serum leptin concentration]

Author

J M, Fernández-Real, R, Casamitjana, and W, Ricart-Engel

Subjects
Adult, Leptin, Male, Analysis of Variance, Sex Characteristics, Anthropometry, Proteins, Glucose Tolerance Test, Insulin Secretion, Linear Models, Humans, Insulin, Female, Insulin Resistance
Abstract

Although its effects in man are still unknown, leptin may play a role in the regulation of insulin sensitivity and insulin secretion. The aim of this study was to determine if these parameters are independent predictors of serum leptin levels.Twenty men and 22 women were evaluated through several anthropometric parameters, including percent fat mass (PFM), which was calculated using bioelectric impedance. A standard oral glucose tolerance test (OGTT) was performed in all subjects. Insulin sensitivity (SI) and insulin-secretion (AIRg) were determined through minimal model analysis.Area under the curve for glucose (AUCglu) and insulin (AUCins) levels after OGTT correlated with serum leptin level in men (r = 0.58, p = 0.005 and r = 0.72, p0.0001, respectively). Only AUCins was associated with serum leptin levels in women (r = 0.50, p = 0.01), but this correlation disappeared after controlling for PFM. A linear correlation between serum leptin level and SI was observed (r = -0.67, p = 0.001, in men; r = -0.82, p0.0001, in women). In a multiple regression analysis, PFM (p = 0.0005), waist-to-hip ratio (p = 0.007) and SI (p = 0.007) independently predicted serum leptin level in men (R2 = 0.82). In women with normal OGTT, only PFM (p = 0.0005) and insulin-secretion (p = 0.02) predicted serum leptin level (R2 = 0.85).Insulin-sensitivity in men, and insulin-secretion (calculated after intravenous glucose) in women independently predict serum leptin level. Furthermore, insulin response after oral glucose is independently associated with serum leptin level only in men. Leptin is a marker of insulin resistance in man, and, in this sense, might confer cardiovascular risk.

Published
1999

38. Leptin is involved in gender-related differences in insulin sensitivity

Author

J M, Fernández-Real, R, Casamitjana, and W, Ricart-Engel

Subjects
Adult, Leptin, Male, Sex Factors, Anthropometry, Body Composition, Electric Impedance, Humans, Proteins, Female, Obesity, Glucose Tolerance Test, Insulin Resistance
Abstract

Although the effects of insulin on leptin levels are relatively well characterized, the possible actions of leptin on insulin sensitivity are not so well studied. This study was undertaken to examine whether gender-related differences in insulin sensitivity could be explained partially by leptin levels.The study involved 22 women (13 obese) and 20 (11 obese) fat mass- and age-matched men. All participants were healthy.Several anthropometric measures of body fatness were quantified and the percentage of body fat was determined through bioelectric impedance. Oral glucose tolerance test and a frequently sampled intravenous glucose tolerance test was performed in all subjects. Serum leptin was measured by radioimmunoassay.Nine lean women (BMI 20.4 +/- 2 kg m2 mean +/- SD) showed increased leptin levels (7.8 +/- 2.7 vs. 4.3 +/- 1.3 micrograms/l, P = 0.003), increased insulin sensitivity (5.2 +/- 1.3 vs. 2.9 +/- 0.9 min-1/mU/l, P = 0.001) and similar fat mass (11.1 +/- 3.7 vs. 13.2 +/- 7.8 kg, P = NS) in comparison with 9 age-matched lean men (33.6 +/- 6 vs. 34.5 +/- 6.3 years, P = NS). Thirteen obese women (BMI 32.5 +/- 2.7) kg m2 also showed increased leptin levels (29.6 +/- 8.4 vs. 11.7 +/- 4.8 micrograms/l, P0.0001), increased insulin sensitivity (1.7 +/- 0.7 vs. 0.95 +/- 0.9 min-1 mU/l, P = 0.04) and similar fat mass (34.4 +/- 8.0 vs. 30.9 +/- 9.6 kg, P = NS) in comparison with 11 age-matched obese men (34.5 +/- 7.8 vs. 38.7 +/- 8.2 years, P = NS). A strong linear association between leptin levels and insulin sensitivity (Si) was found (r = -0.67, P = 0.001, in men; r = -0.82, P0.0001, in women). After controlling for percentage of body fat, this association remained significant only in men (r = -0.56, P = 0.01, in men; r = -0.30, P = NS in women). In stepwise regression analysis models, both gender (P = 0.00001) and leptin (P = 0.00001) contributed to 67% of the variance in Si independently of body fat.Leptin levels and gender contribute to the variance of insulin sensitivity, independently of body fat. These results suggest that leptin could affect insulin sensitivity.

Published
1999

40. [Reversible hypophyseal disfunction and hyperplasia in two cases of primary hypothyroidism]

Author

J M, Fernández-Real, W, Ricart, C, Porcar, and J, Teruel

Subjects
Hyperplasia, Adolescent, Hypothyroidism, Pituitary Gland, Pituitary Function Tests, Humans, Female, Middle Aged, Hypopituitarism
Abstract

Some patients with primary hypothyroidism (HP) develop massive thyrotrope cell hyperplasia determining pituitary hyperplasia with suprasellar enlargement and pituitary dysfunction. Although TRH secretion undoubtedly has some influence, the intervention of other possible factors determining this hyperplasia and dysfunction has been little assessed.Two patients with primary hypothyroidism with a serum TSH1,000 mU/I were studied. By means of CT and MR a pituitary hyperplasia was ascertained in the two patients. The pituitary functional reserve was investigated by the serum response of TSH and prolactin to the administration of TRH (400 micrograms, i.v.), bromocriptine (BRC, 5 mg, oral route), somatostatine (ST, 50 micrograms/kg/min, i.v. perfusion), and gonadotropin releasing hormone (GnRH, 100 micrograms, i.v.).The TRH induced increment of TSH was 145% and 193%, respectively, compared with basal values. After the administration of BRC, TSH decreased to 57% and 84% of basal values, and PRL to 46% and 43%, respectively. TSH and PRL concentrations did not change after the administration of ST or GnRH. In both cases, hyperplasia and pituitary dysfunction returned to normality after substitutive therapy with levothyroxine.Basal hyperprolactinemia and TSH and PRL responses to BRC administration suggest that central dopaminergic activity is decreased or abolished in patients with HP and pituitary hyperplasia. The massive thryrotrope cell hyperplasia and hypothyroidism itself determine pituitary dysfunction, which reverts after therapy with levothyroxine, a fact which is scarcely documented in literature.

Published
1998

41. [Early diabetic nephropathy in a patient with agenesis of one kidney]

Author

M, Matas, M, Vallés, J, Bronsoms, G, Maté, W, Ricart, L, Bernadó, and J M, Mauri

Subjects
Adult, Diabetes Complications, Male, Humans, Diabetic Nephropathies, Kidney
Abstract

A 24 year old male diagnosed of type II diabetes mellitus of 2 years of known clinical evolution discovered by an episode of hyperglycemic decompensation without ketoacidosis is presented. In the study of possible visceral involvement of the disease agenesis of the left kidney with compensating hypertrophy of the right kidney, increase of glomerular filtrate and proteinuria of 1.8 g/24 hours were observed. Renal histologic study demonstrated the existence of diffuse intercapillar glomerulosclerosis compatible with diabetic glomerulopathy. From these data and review of the literature the possibility of the greater risk of individuals with a single kidney to present nephropathy in the case of coexistence of associated diabetes mellitus.

Published
1993

42. [Evaluation of the nutritional status through determination of anthropometric parameters: new charts for the working population of Catalonia. Group for the Evaluation of body composition in the population of Catalonia]

Author

W, Ricart, F, González-Huix, and V, Conde

Subjects
Adult, Male, Adolescent, Anthropometry, Health Status, Body Weight, Age Factors, Nutritional Requirements, Nutritional Status, Middle Aged, Nutrition Surveys, Body Height, United States, Skinfold Thickness, Sex Factors, Reference Values, Spain, Body Composition, Humans, Female, Aged
Abstract

Body composition measure by anthropometric parameters permits the detection of populations at risk of developing diseases with greater impact in public health and provides standard values of normality of nutritional state.A prospective transversal study was carried out with a randomly selected sample of 6,445 individuals taken from 25,279 workers evaluated in Safety and Hygiene Centers during 1990. Chronically ill patients were excluded with 5,019 healthy individuals between 16 and 65 years of age being selected. The following data were obtained: height, weight, skin fold of the biceps and triceps, subscapular and abdominal and arm perimeter. Calculation of the weight/height, weight/height, weight/height, sum of two and four folds, mid-arm muscle circunference, area fo the arm, muscle area of the arm, adipose area of the arm and muscle adipose index was performed.The tables of the percentiles 1, 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, and 99 of the anthropometric parameters according to sex and age are presented. Significant differences were found among the age groups for the fat parameters which were greater from the third decade for the fold of the fat of the trunk in males and from the fourth decade of the fat parameters of the trunk and extremities of females. The muscle parameters successively increased in both sexes and for each age group up to the fourth decade and thereafter remained stable.The values of the anthropometric parameters may be used as standard patterns of the working population in Catalonia. The differences between sexes and age groups, such as with the values of the Catalan population previously referred and those of the American population, indicate that the anthropometric measurements of body composition must be periodically determined to ensure adequate standards of each population.

Published
1993

43. Estudio de las mutaciones A3243G, C3256T y deleciones mitocondriales en 41 pacientes diabéticos

Author

M Fernández-Castañer, Nunes, I Rojas, J Biarnésa, W Ricart, and M Gómez

Subjects
Gynecology, medicine.medical_specialty, business.industry, medicine, General Medicine, business
Abstract

Fundamento Las mutaciones y/o deleciones del ADN mitocondrial caracterizan un nuevosubtipo de diabetes. Pacientes y metodo Se estudiaron las mutaciones A3243G y C3256T y deleciones mitocondriales en 41 pacientes diabeticos con antecedentes maternos de diabetes y/o sordera neurosensorial. Resultados La mutacion A3243G se detecto en un paciente (2,4%). En ningun paciente se detectaron la mutacion C3256T ni deleciones mitocondriales. Conclusiones La busqueda de la mutacion A3243G debe considerarse ante la presenciade diabetes con herencia materna y sordera neurosensorial asociada.

Published
2001
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45. [Limitations of CAT scan in the diagnosis of myelolipoma of the adrenal gland]

Author

E, Gómez Martinench, F, Catanyer Corretger, J, Ferrer Subiros, J, Pont Valles, R, Bassaganyas Vilarrasa, W, Ricart, and A, Grau

Subjects
Diagnosis, Differential, Adipose Tissue, Adrenal Gland Neoplasms, Humans, Lipoma, Tomography, X-Ray Computed
Abstract

The suprarenal myelolipoma is a myeloid tissue and fat tissue tumor. It can undergo degenerative processes of haemorrhage, necrosis and calcification. The diagnostic key is based on the finding of fat tissue in the inside of a suprarenal mass. A CAT would be the method allowing a more accurate diagnosis. Its limitations came from the presence of myelolipomas with abundant myeloid tissue, or which have suffered major degenerative processes in which it is difficult to identify the fat tissue, and in large retroperitoneal masses in which it is impossible to recognize their suprarenal origin.

Published
1990

47. Short-term mortality of myocardial infarction patients with diabetes or hyperglycaemia during admission.

Author

J. Sala, R. Masiá, F-J. González de Molina, J.M. Fernández-Real, M. Gil, D. Bosch, W. Ricart, M. Sentí, and J. Marrugat

Subjects
MYOCARDIAL infarction, DIABETES
Abstract

Aim: The hypothesis that patients with hyperglycaemia during admission, regardless of previous diagnosis of diabetes, have worse prognosis than those with normal glucose values is controversial. The objective was to assess the role of hyperglycaemia on short-term mortality after myocardial infarction (MI). Methods and Results: A cohort study nested in a prospective registry of MI patients in the reference hospital of Gerona, Spain was performed. All consecutive MI patients under 75 were registered between 1993 and 1996. Patient and clinical characteristics, including previous diagnosis of diabetes, glycaemia on admission and in the next four days, were recorded. Patients with glycaemia on admission or four day mean glycaemia >6.67 mmol/l were considered hyperglycaemic. The main outcome measure was mortality at 28 days. Of 662 patients with MI included, 195 (29.7%) had previously known diabetes mellitus, but 457 (69.0%) had glycaemia >6.67 mmol/l on admission. Patients with hyperglycaemia on admission were older, more often female, more frequently had a previous diagnosis of diabetes, developed more complications, and had higher 28 day mortality. The effect of admission glycaemia >6.67 mmol/l on 28 day mortality was independent of major confounding factors, particularly previous diagnosis of diabetes (OR=4.20, 95% confidence intervals 1.18 to 14.96). CONCLUSIONS: Higher 28 day mortality was observed among MI patients with glycaemia on admission >6.67 mmol/l compared with patients with lower levels, independently of major confounding variables and, particularly, previous diagnosis of diabetes. This early, simple, and inexpensive marker of bad prognosis after MI should prompt the application of more aggressive treatment of MI and risk factors and, probably, of glycaemia during admission. [ABSTRACT FROM AUTHOR]

Published
2002
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49. [Multiple symmetrical lipomatosis and chronic alcoholism]

Author

A, Grau Martín, F, González-Huix, W, Ricart Engel, M, Masabeu Urrutia, D, Acero Fernández, and S, Soler Simón

Subjects
Male, Alcoholism, Lipomatosis, Multiple Symmetrical, Humans, Middle Aged, Aged
Abstract

Multiple symmetric lipomatosis (MSL) is characterised by nonencapsulated localised lipomatous accumules (type I) or diffused (type II). There is a high incidence in Mediterranean males with high alcohol intake. The biochemical blood alterations described are similar to those related to alcoholism or chronic hepatopathy. The disease can be associated with demyelinating peripheric or autonomic neuropathy and in MSL type I with mediastinal findings of 5 patients suffering from MSL type I, comparing them with the cases in the literature and insisting on the participation of alcoholism (early onset, important amount, and long-term habit) in the etiology of MSL and its contribution to the developing of neuropathy and abnormalities of lipidic metabolism.

Published
1989

50. Evaluation of B-cell function in diabetics by C-peptide determination in basal and postprandial urine

Author

M, Fernandez-Castañer, P, Rosel, W, Ricart, E, Montaña, J M, Gomez, M A, Navarro, and J, Soler Ramon

Subjects
Glycated Hemoglobin, Male, Eating, Islets of Langerhans, Diabetes Mellitus, Type 1, C-Peptide, Diabetes Mellitus, Type 2, Reference Values, Creatinine, Humans, Female
Abstract

Urinary C-peptide (UCP) values in basal and postprandial 2-hour samples are compared with simultaneous plasma C-peptide (PCP) values and with 24-hour UCP in 21 NIDDs, 24 IDDs and 9 controls. Basal and postprandial 2-h UCP was similar in controls and NIDDs (0.79 +/- 0.53 and 2.68 +/- 1.06 nmol/2 h versus 1.03 +/- 0.70 and 2.64 +/- 1.34, p greater than 0.05) and very low in IDDs (0.16 +/- 0.22 and 0.58 +/- 0.86, p less than 0.001). NIDDs showed basal (0.69 +/- 0.32 nmol/l) and postprandial (1.12 +/- 0.50) PCP values lower than controls (0.91 +/- 0.31 and 1.90 +/- 0.70). UCP clearance was higher in NIDDs than in controls. IDDs showed similar pattern of higher clearance but greater variability, the differences not being significant. It is concluded that despite correlations between PCP and UCP, possible differences can exist in C-peptide renal handling in diabetics, making unwise to use UCP as sole parameter of B-cell function in these patients.

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